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elcome to Issue 5 of JUNKMAIL, AIVL’s national drug users’ magazine. Between issues, we are constantly receiving feedback from drug users about JUNKMAIL. While we are pleased to say that the vast bulk of the feedback that we receive is really positive, we also receive constructive criticism on how to improve JUNKMAIL, and most importantly, how to make it more accessible and appealing to drug users.

ultimately, read by drug users. The fact that as drug users, we have regularly produced a high quality, professional magazine should be a source of some pride for the Australian drug users’ movement. Along with the comments about the ‘format’ of the magazine, we also received feedback relating to the distribution of JUNKMAIL. In some places it seems, the available copies of JUNKMAIL were being snapped up by service providers before local users could get their hands on them. While our investigations indicate that this is by no means a widespread problem, it does highlight the important issue of how our member organisations distribute JUNKMAIL throughout their state/territory and whether they are making sure that as many copies as possible are making it into the hands of drug users.

One of the most important pieces of feedback that we received in the past few months, related to the quality of the magazine. Remarkably, because JUNKMAIL is well produced, a few drug users from one particular part of the country thought that it maybe “too good for them.” Apparently, they believed that the glossy and professional look of the magazine must mean that it was a publication for service providers - not drug users. In one way, I feel really sad about the fact that a group of users think that they are ‘not good enough’ for anyone to produce a glossy magazine for them. On the other hand however, I am really glad that we received this feedback because it gives us a chance to try and find a solution to this ‘image’ problem. As part of understanding the ‘look’ and ‘format’ of JUNKMAIL, it is probably important to outline why AIVL decided to produce the magazine in the way that we do. JUNKMAIL is primarily a ‘policy’ magazine and this means that the aim of JUNKMAIL is to get drug users interested in the ‘policy’ issues that affect them. This is a tough assignment for a drug user’s magazine, as it invariably involves publishing longer articles that explore complex issues - a place where users can debate and discuss issues and hopefully, over time develop the ability to think critically about those issues. We wanted to produce a very different magazine to the local drug magazines which mostly focus on eduction through safer using information, harm reduction messages and user’s stories. We also wanted to produce a high quality magazine that valued the intelligence and experiences of drug users. We decided to do this by producing a professional looking magazine which said to drug users “AIVL thinks that you deserve a magazine that looks as good as it reads”.

Due to funding restraints, we can only print 5000 copies of each issue of JUNKMAIL. Of course, this print run is by no means adequate to reach the millions of illicit drug users across Australia. So, we need to think creatively about how we get JUNKMAIL to its intended readership. Currently AIVL divides the 5000 copies of JUNKMAIL amongst the states and territories loosely based on the size of the drug using population in each jurisdiction. The challenge, which is clear from the feedback we have received, is how we get the limited copies, delivered to our member organisations, into the hands of local drug users before they are snapped up by others working in the area. The answer to at least part of this challenge, lies with service providers themselves. While AIVL understands that JUNKMAIL carries information and perspectives that are very useful for people providing services to drug users, JUNKMAIL is produced primarily for drug users. AIVL believes that given the small numbers of JUNKMAIL available, service providers should always act to make sure that local users get access to any available copies of JUNKMAIL before they take copies for their own purposes. To demonstrate to our readership that we take their feedback seriously, we have made some changes to this current issue such as: • From this issue forward, JUNKMAIL will carry a ‘stamp’ on the front cover that declares it a magazine “produced by drug users for drug users”. We have done this so that drug users seeing JUNKMAIL will know immediately that this magazine has been put together by other users and is meant to be read by users;

We wanted to extend the concept of “user ownership” to all aspects of the magazine and in this sense each issue of JUNKMAIL is; planned by drug users, the articles are written by drug users, it is edited by drug users, illustrated and designed by drug users and

• We have included more user’s stories in this issue as a way to make the discussion of complex and sometimes quite ‘dry’ policy and government issues more accessible; • We have revived the Trivia Quiz from Issues 1 & they were very popular with readers and are a fun



2 as way to


Editorial Contents & Credits An Aussie in London Looking into the Crystal Ball...Hep C the Problem Ain’t Over Yet! Heroin Trials...Where has all the Anger Gone? Service with Attitude - A Story About Rehab & Hep C My Detox Experience Retractable Needles & Syringes - Whatsup?

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CREDITS

Writing Junky - De Quincey’s Confessions & the Origin of Addiction Doctor Shopping Sex, Drugs & Rock’n’Roll Trivia Quiz Liquid Handcuffs - What’s Wrong with the Methadone Program? The Price is Right - Returns on Investment in NSPs Report It’s Different in the Territory Mate! Mad, Bad & Dangerous... Psychostimulant Users Beware! Methadone Enhanced Health Treatment Service Printing:

Editor: Co-editor: Editorial Board:

Annie Madden, AIVL Executive Officer Nicky Bath AIVL Policy Officer Charles Roberts, Paul Gill and Michael Blackwell

Thanks to:

The rest of the AIVL staff team: Jude

Byrne, Dayle Stubbs, Beth Harvey, Skye Jewel for their input. All of the

individual drug users and others who have contributed articles to this edition.

Australian Injecting & Illicit Drug Users League (AIVL) Address: Level 2, Sydney Building

112-116 Alinga Street Canberra, ACT 2601.

GPO Box 1552 Canberra, ACT 2601 AUSTRALIA

Telephone: Facsmile: Email: Website:

Postal:

Graphic Design, Layout and Illustration:

John Carey Arts

Goanna Printing, Canberra

(02) 6279 1600 (02) 6279 1610 anniem@aivl.org.au www.aivl.org.au

DISCLAIMER The contents of this magazine do not necessarily represent the views of the Australian Injecting & Illicit Drug Users League Inc. (AIVL). AIVL does not judge people who choose to use illicit drugs, and Junkmail welcomes contributions which express opinions and raise issues of concern to people who use or have used illicit drugs. The contents of Junkmail do not encourage anyone to break the law or use illicit drugs. While not intending to censor or change their meaning, Junkmail reserves the right to edit articles for length, grammar and clarity. Junkmail allows credited reprinting by drug user organisations and other community-based groups with prior approval, available by contacting AIVL. Information in this magazine cannot be guaranteed for accuracy by AIVL. AIVL takes no responsibility for any misfortunes which may result from any actions taken based on materials within Junkmail and does not idemnify readers against any harms incurred. The distribution of this publication is targeted - Junkmail is not intended for general distribution.

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n an effort to give Australian users and others in the Australian community a sense of what it is really like to be on a heroin prescription program and to highlight just how much being on such a program can improve people’s daily lives, Junkmail asked ‘Aussie in London’ Erin O’Mara, to gives us a first hand account of life when the heroin you use each day is legal... Each day, at a pace that’s my own, I walk round the corner to my local chemist and I pick up 1/2 a gram (500mg) of pure, pharmaceutical heroin. I receive it in its injectable form - a white, freeze dried powder sealed and sterilized in five small glass ampoules, each one containing exactly 100mg of pure pharmy smack. Packaged in a small blue and white box, it’s almost disconcerting that its label merely reads “diamorphine hydrochloride” and doesn’t scream, as methadone can, “STATE MEDICATION FOR F****D UP JUNKIES”. Despite the fact that heroin is available on prescription here in the UK, it is very rarely prescribed to drug users, which means, as I leave the chemist for home each morning, I still feel like I’m clutching the winning lottery ticket under my arm - MY NUMBERS HAVE FINALLY COME UP and yes, it has completely transformed my life! So is it the perfect ‘script? Well it certainly has been for me. Most of my mates wish they had the same, that if only they had a heroin ‘script they wouldn’t have to use illicitly anymore. And as they bounce from one methadone programme to the next in their painfully slow and humiliating tour of drug clinics and doctor’s surgeries, I’m definitely inclined to agree. Years of blanket methadone prescribing for each and every user who’s ever looked for some sort of stability has landed us in a situation where poly drug use is now the norm. The low-lying brain fog of a methadone maintenance ‘script colludes to block out any joy had from a shot of heroin - nothing that a few benzos and beers won’t fix - and the cracking whip of treatment becomes a series of failures, dirty urines, punishments and secrets. I know I’m fortunate. As an Aussie living in London, there are times when I have to pinch myself that this is real. That the long and often harrowing road of ‘substitute prescribing’ has finally come to an end - and now I’m free to think about my future. But in the small silences that fall between me counting my blessings, I can’t help but wonder whether it’s all just been a bit too little, a bit too late. I question why it has taken eighteen long years to get here? Why did I have to wait until I’d been chewed up and spat out of over ten

different treatment programmes and doctor’s surgeries, of at least four rehabs and an uncountable number of detox attempts? Why did I have to wait until I’d ‘finished’ selling my young body to men, ‘til I’d got sick and deeply depressed, ‘til I’d used every vein in my body from my neck to my feet, ‘til I’d contracted both HIV and Hep C? Yet doctors can prescribe heroin to people who are opiate dependant in the UK and indeed they have recently been encouraged to by our current Home Secretary, David Blunkett. So what has happened to the UK’s famed heroin prescribing system and what parts of it should Australia attempt to import when considering it? At the root of the famed ‘British System’ of prescribing of the 1960’s was the giving of pharmaceutical heroin, under medical supervision, to those who were heroin dependant. My ex-partner was fortunate enough to be a part of that evolution and it fared him well at the time. Now he may have to give his right leg (literally, he shoots methadone ampoules into his femoral vein) before they will prescribe him a suitable heroin ‘script. In 1968, the clinic system was introduced which effectively took away a doctor’s discretion in the prescribing of controlled drugs. It was to be known as “the abolition of free prescribing” and it was at this juncture that Britain took a fateful step, a step much more in line with America and down a road going nowhere fast. Today, the extent and the approach towards heroin prescribing is schizophrenic. Doctors are required to apply for a special government license, one that’s rarely issued and when it is, it’s not often used for treating opiate dependence. But although ignorance and fear are usually the building blocks on which new UK Government drug policies/initiatives are based, occasionally one sees a glimmer of hope. For British opiate users, this has appeared in the Home Secretary’s recent declaration that there would be more heroin programmes available to drug users in the near future, however the planning behind how any new programmes are to be implemented, does not seem well thought out. It appears to have fallen to a new government think tank that has been given the task of focusing on various aspects of drug “misuse” and treatment, but where this new “National Treatment Agency” is headed, noone seems quite sure. Meanwhile, only 449 people currently receive a heroin prescription for opiate dependence and 96% of all opiate based prescriptions given out to British users, remains methadone.




In the ten years since I’ve been in the UK, I’ve had the opportunity to participate in two very different approaches to heroin prescribing - and it has taught me a great deal about how the differing structures, regulations and nuances behind the way heroin is administered to users, is critical to the success of the programme. For example, the first heroin ‘script I received was through a pilot project in Chelsea London, whose aim it was to study the effectiveness of prescribing either pharmaceutical heroin, or methadone in injectable form to drug users. (In the UK, methadone is available in linctus, tablet and ampoules for IM injection).

......The importance of maintaining an environment where users can talk openly and honestly to their keyworkers and consultants is a crucial element in a person’s success on any drug treatment programme .......

Their first mistake and one eventually admitted, was to limit the amount of diamorphine prescribed, to an unmanageably low 200mg (the Swiss, the Dutch and others, myself included, have found 400 - 1000mg much more suitable). Pharmaceutical heroin does not have a long half-life and to seriously underestimate the dosages required was to become a momentous error and one that would seriously jeopardise a person’s ability to adhere to their prescription. With a median age range of thirtyeight and an average injecting career of nineteen years, many clients at this project had other drug problems, such as crack, benzodiazepines, alcohol or cocaine which I don’t fully believe were taken on board at the time.

The severely punitive clinic regulations or ‘protocols’, would bear this out. i.e. anyone caught using any other drugs or ‘topping up’ their rather limited dose, would immediately be ‘sanctioned’ by way of a 30mg reduction in ones daily prescription, reducing even further ones ability to adhere to the programme. Once one’s prescription began to lower, it was practically impossible not to ‘top up’ with something else, and so clients, myself included, were locked in a constant spiral of ‘script alterations. A stifling clinic environment would be the clinics’ second fundamental error, where people would be unable to talk about

their other drug issues for fear of a variety of repercussions. This would lead to an even more alarming situation where clients hid serious medical issues for fear of their prescription being stopped or being transferred back to methadone linctus. The importance of maintaining an environment where users can talk openly and honestly to their keyworkers and consultants is a crucial element in a person’s success on any drug treatment programme, and this was no exception. A deeply unhappy client group had nowhere to go to complain about their treatment and attempts by users, myself included, to engage the staff in discussion, were promptly nipped in the bud. Having to attend to such a stressful and demoralising project promptly each morning in order to receive one’s medication only exacerbated people’s depression and did little if anything to improve the spirits of those attending. One minute’s tardiness and the doors would be closed in your face. We may as well have still been on ‘done. While I have only touched on a couple of the problems this particular approach to heroin prescribing had, there were many others of which there isn’t the space to discuss in this piece. Suffice to say, that if Australia is to take on diamorphine prescribing, they would do well to take serious note of some of issues and concerns around clinic or surgery structures - by the people that actually use the service. After two of the most miserable and difficult years of my life at this clinic, I left as my 200mg prescription sat at the severely reduced level of just 80mg (!!). I was deeply unhappy, and still using on top. While it may not have been a failure for everyone, they had sure made it damn hard to succeed. Two years later, after a desperately unsuccessful period on an injectable methadone prescription, I had developed a dire crack problem, was drinking alcohol regularly for the first time in my life, and began having regular seizures from increased benzodiazepine use. It was at this time that, after an enormous effort, I managed to secure a place at London’s famous Maudsley Hospital, where there was a doctor prescribing heroin to a small group of patients. I clearly remember my sense of complete and total desperation. I felt I could not go on any longer, that if they didn’t help me I would be - I didn’t know where I would be and that was the trouble. I felt that this was my last hope, that I’d tried everything. And I begged... most drug users know well the feeling of someone else, a doctor, having the power of your life in their hands, every single day. A ‘script started or terminated making the difference between life and death, or misery and hope. Sometimes you end up having to beg... My assessment was rocky, my doctor probing. I had completely collapsed most of my veins by injecting methadone, an acidic preparation made for intramuscular injection, that the vast majority of British users inject intravenously. Why they haven’t developed an intravenous solution is anyone’s guess but I expect it’s for the usual reasons: “Don’t give them what they want”. But it’s not about ‘want’ anymore. A chemical dependence is about ‘need’. Over the period of a few days, I made the uncomfortable but necessary transition from 200mg of methadone injectables, to 500mg of diamorphine




hydrochloride. Converting a methadone prescription to pharmaceutical heroin is another area Australia would do well to ensure they get correct if heroin prescribing is introduced. The clinic at Chelsea relied on the inaccurate assessment that 1mg of methadone was equal to 1mg of diamorphine proving a costly error for all concerned. A more precise estimate is 1mg methadone to 3 or 4mg of diamorphine.

national drug users’ magazine called “Black Poppy”, and I am actively involved in drug user politics, journalism and harm reduction issues. It has been a difficult journey, but thanks to my mum, my mates and the open-mindedness of my doctor, who fully engages me in my treatment decisions and doesn’t wave punishments in my face, I have stabilized and am well, for the first time in eighteen years of using opiates. Now, I have somewhat of a vested interest in the campaign towards prescribing heroin in Australia. Last year, my mum returned to Australia to live and while I would have liked to go with her, the thought of losing my heroin ‘script after fighting so hard to get it, felt more than I could bear. I am HIV positive. There are going to be times when I will want to be near my family. Yet archaic laws in Australia forbid me from even entering the country with my prescription. How can this be legal? Anyone, on any other medication, would be permitted to continue that medication in another country but these basic human rights do not extend to drug users.

The method by which I was prescribed heroin this time seemed like the polar opposite of Chelsea. I was taken seriously when I said I needed more, the dosage being increased until I said I was comfortable. For me, this was at 500mg, more than double the Chelsea clinic had offered. My doctor would see me once every two weeks and I was to pick up my prescription at my local chemist. Back then, I felt the doors open for me for the first time. I felt in control of my use and did not have to arrange my day around clinic hours.

The intense and totally unfounded hysteria that surrounds the prescribing of heroin to drug users sadly endures and has made the campaign to prescribe heroin in Australia a momentous task. Yet while campaigners look to the British System for guidance, it would be a mistake not to closely examine both its failings and successes. The potential for problems in importing a system that hasn’t been culturally fine-tuned for the Australian using community are great, because to get it wrong, Australia may lose the chance to ever attempt it again. The Swiss users have to return to their heroin prescribing clinic three times a day to receive their heroin, watched over as they inject by a clinic nurse. Although the Swiss programme has had incredibly positive results, would Australian users blossom under such a severe restriction of an individual’s freedom? Or if the dosage is not allowed to be adjusted to suit each individual, as occurred at Chelsea, what chance is there of success? While there is undoubtedly a role for the prescribing of heroin to heroin users, it is important to remember how crucial the role of the heroin user is in the planning, implementation and evolution of a heroin programme. Users must be involved every step of the way and accepted, as other users of health services are, as an integral part of a programme’s development, with rights, responsibilities and a mutual respect for experience. Take the best bits out of the British system, and don’t bring the worst - it will be users that will ultimately pay. And that means their families and their communities as well.

Although I entered the programme with multiple habits (crack, methadone, heroin and pills), having a heroin prescription was not going to sort all these issues out. While the support of my mum who lived in the countryside had always been there, I had previously been unable to benefit from this because, like most people in treatment, I was rarely offered takeaways. Despite my mothers’ protests, it wasn’t often that I got the chance to stay with her for more than a weekend at a time. This time round however, it was precisely because my doctor recognised the importance of my mothers support and was able to assist our relationship by giving me the necessary take-aways to stay at her house, that I was able to recover so swiftly. Within four months, I had stabilised and had stopped using all other drugs aside from my prescription.

So these days, my life might not be perfect, but it’s not perfect for all the right reasons. Now my daily concerns revolve around my work and deciding what to have for dinner and not how the hell am I going to get the money for my gear today. I may still be drug dependant, but I don’t suffer from a drug problem. I have finally been given the respect I deserve and most importantly, I’ve been given back control over my own body. I pray that one day, and sooner rather than later, Australia implements heroin prescribing - and I can come back home.

I have now been on my heroin script for two and a half years. My health has improved substantially and my HIV doctor is delighted - as is my mum and I. My moods and energy levels have improved considerably and so has my ability to contribute to life and my community. I founded and continue to work on what has become a

by Erin O’Mara




ack in June 2001, AIVL was invited to sit on the Australian National Council on AIDS, Hepatitis C and Related Diseases Hepatitis C Committee’s - Hepatitis C Virus Projections Working Group. Now, this is all a bit of a mouthful so here is a diagram to help you understand the relationship of these committees to each other. This is important as, these committees meet to discuss and act in relation to Hepatitis C which is sadly a continuing major issue for injecting drug users. Australian National Council on AIDS, Hepatitis C & Related Diseases (ANCAHRD) ANCAHRD HIV Committee

ANCAHRD HEP C Committee

CTARC (Clinical Trials & Research Committee)

IASHC (Indigenous Australians’ Sexual Health Committee)

by telephone and communicated in between by email. The Hepatitis C Virus Projections Working Group aimed at meeting the following objectives: • to provide updated consensus estimates of hepatitis C incidence and prevalence in Australia; • to estimate the number of people living with hepatitis C by stage of liver disease; • to estimate morbidity associated with hepatitis C infection; • to obtain projections of the long-term sequelae of hepatitis C infection; including cirrhosis, liver failure and hepatocellular carcinoma and hepatitis C related mortality; • to recommend a mechanism for updating and improving estimates over time.

So what did we find out?

ANCAHRD Legal Working Party

General information: (this was assessed by reviewing available research reports and statistics) • The number of infections amongst injecting drug users is strongly associated with the duration of injecting and age. • Around 65 percent of notifications of people with hepatitis C have been in people aged 20-39 years, with 35 percent of notifications in females. The proportion of female hepatitis C notifications is larger than 35 percent in younger age-groups. In particular, in the 15-19 year age group, similar numbers of men and women are notified. • 80 percent of infections have occurred through injecting drug use. • Studies undertaken within some prisons is showing that at a national level it is estimated that 30-40 percent of all prisoners have hepatitis C however, for women this is likely to be higher and in the range of 50-70 percent.

Hepatitis C Virus Projections Working Group

The task of this sub-committee was to estimate and project the impact of hepatitis C within Australia. This is important because it helps the Government and other organisations, (including AIVL and all of the state and territory drug user organisations) to see what they need to be doing and plan for the future in relation to public health responses for prevention and treatment. The working group was made up of various key players from the field including reseachers, doctors, government representatives and people affected by hep C and, we all worked well together.

Health issues:

So what did we do? The working group was coordinated through the National Centre in HIV Epidemiology and Clinical Research (NCHECR). We met monthly



• At most 25 percent, probably nearer 10 percent, of people who develop anti-bodies following exposure to hepatitis C experience an acute illness, the majority experience no illness at all at the time of infection. • Around 25 percent of people exposed to hepatitis C clear the infection and are not at risk of long term hepatitis C morbidity or mortality.


• Estimate the contribution to new infections that prisons, juvenile justice systems, during drug treatment programs and in novice users; • Evaluate the effectiveness of hepatitis C prevention especially needle and syringe programs and methadone treatment; • Further study is needed on hepatitis C related morbidity and financial cost of hepatitis C infection.

Estimates and Projections A Brief Summary • It is estimated that 210,000 people are living with hepatitis C in 2001. • The report shows that the number of people living with hepatitis C-related cirrhosis, new cases of liver failure and liver cancer were all projected to at least treble by the year 2020. • It is also estimated that there will be between 321,000 and 836,000 people living with hepatitis C in 2020 depending on future patterns of injecting drug use. • Total quality of life of people living with hepatitis C was estimated to be substantially impaired, with much of this impairment in people with little or no liver damage. • Since the beginning of the Hepatitis C epidemic in Australia it was estimated that there had been 1,000 cumulative hepatitis C related deaths. • The vast majority of people with hepatitis C will not face serious liver damage or a life-threatening situation.

So what does it all mean? It seems that hepatitis C will remain a health issue particularly for injecting drug users for some time and we have a great deal of work to do. At AIVL we will persist in fighting for our existence and ensure that we continue to produce hep C education resources and policy responses to enable injecting drug users to continue to take control of their drug use and health. We believe that this is not an ‘either or’ situation. Injecting drug users should be able to use knowing that they are not at risk of jeopardising their health in any way. However, we cannot do this alone. Our state and territory member organisations need to be funded and equipped to continue with the amazing and valuable work that they do to reduce the risk of hep C tranmsission for injecting drug users. Needle and Syringe Programs need to be resourced and expanded upon, treatment options need to increase in quality, choice and availability and we need to repeal self administration laws across Australia. And you, what can you do as an individual drug user? Continue to fight for your rights, continue to use safe injecting practices and continue to look out for yourself and your peers. You see, when it comes to hep C it is a huge challenge, but we are all succeeding in some ways because if we were not, the numbers of infections would be higher than they are. Hold on to what we are doing well and strive for improvement. Together we will win, it may take a while yet but, we will get there!

What else do we need to do? • Attempt to estimate the number of duplicate notifications of people who have hepatitis C (this means people who have been counted as having hep C more than once) particularly between state/territories; • Develop methods to monitor systematically the number of new hepatitis C infections each year (incidence rate) in injecting drug users; • Further improve estimates of numbers of injecting drug users and the effect of the heroin drought on these numbers;

Data used in this article is taken from the ANCAHRD Hepatitis C Committee, Hepatitis C Virus Projections Working Group: Estimates and Projections of the Hepatitis C Virus Epidemic in Australia 2002 (August 2002) Report.

Take a trip to www.aivl.org.au and tell us what you think... we’re all ears!




the proposed trial stating that they were unwilling to amend the necessary federal legislation to allow the trial to proceed in line with international treaty obligations. This act did not just kill off the ACT Heroin Trial, but effectively put paid to any other proposals for heroin trials anywhere in Australia to this day by making it clear, that while he was Prime Minister, his government would never agree to the necessary legislative amendments or monitoring that would be necessary for a heroin trial to proceed in Australia.

hen I think back to the dizzy heights of 1997 when the then ACT Chief Minister, Kate Carnell took the proposal for Australia’s first heroin trial to the Ministerial Council on Drug Strategy (MCDS) and gained their support, I can’t help but feel sad, desperate and disappointed about where the whole issue of heroin trials has ended up in Australia in 2003. I remember the overwhelming sense of relief and hope for the future that I and other users felt on the day that we heard that the police and health ministers from around the country, which made up the Ministerial Council on Drug Strategy, had reached a majority agreement to support the ACT Heroin Trial Proposal. It felt like a moment in history that was just too good to be true... as it turns out; it was too good to be true. Although we were acutely aware that the Prime Minister, John Howard was implacably opposed to a heroin trial in Australia, we were, I have to admit, taken completely by surprise that he would disregard the advice of the most senior health and law enforcement representatives in the country to stop the ACT Trial going ahead.

Just so you know... Following the demise of the ACT Heroin Trial Proposal, there has been some confusion amongst users about why an Australian heroin trial relies so utterly upon support from the Federal Government of the day. On numerous occasions I have heard people ask “why we can’t just use some of the produce from the Tasmanian poppy fields to supply a heroin trial if the Federal Government won’t amend the necessary legislation to allow for the importation of heroin?” While this is a very good and logical question there are a number of quite specific legal and pharmaceutical restrictions that surround the whole issue of heroin trials in Australia and these include... 1. Pharmaceutical Restrictions: The Tasmanian poppy fields do produce one of the largest sources of medicinal opium in the world for the global pharmaceutical market. Unfortunately, the process that is used in Tasmania is a straw poppy based process that is not suitable for the production of opium alkaloids such as heroin. The straw poppy process as its name suggests, involves mowing the entire opium poppy plant into a ‘straw’ like product from which a medicinal opium-based product is made. This product is then sent overseas for further processing into various opium-based medical products.

Perhaps with hindsight one might say that it was naive to underestimate the Prime Minister’s opposition to this issue, but as they say “hindsight is a marvellous thing” and we did not actually expect the trial to be supported by the MCDS in the first place. So, when they came out in majority support of an ACT heroin trial, we thought maybe, just maybe we could be witnessing the beginning of a special moment in Australian history. Before the ink was even dry on the MCDS agreement, the Prime Minister had stepped in and taken the unprecedented decision to set aside the expert advice of the MCDS and take the whole issue into his own hands. In the following weeks the Prime Minister sought, and got, support from his Cabinet colleagues to veto

To produce high grade heroin which would be suitable for any government supported heroin trial or program you would need to use to a different form of processing which separates only the coagulated juice or opium resin from the opium poppy to then produce an opium alkaloid such as heroin. In short,




opium alkaloids cannot be produced in Tasmania with the currently available technology and processing and this means that there is no existing environment in which legal heroin can be manufactured in Australia. Given that heroin trials would only create a relatively small market for medical grade heroin, at this stage it is not in the interests of the Tasmania Poppy Growers to invest in the technology necessary to manufacture heroin in Australia. All of these issues add up to the need for Australia to import heroin from overseas if ever we did run a heroin trial. 2. Legal Restrictions: As well as the pharmaceutical restrictions outlined above, there are also major legal impediments to both the manufacture and importation of legal heroin in or into Australia. Given that there is no currently available source of legal, pharmaceutical grade heroin that can be produced ‘in-house’ in Australia, any government or recognised organisation wishing to ...heroin trials run a heroin trial or program would need to gain permission from the and eventually Federal Government of the day to heroin prescription import heroin into Australia for the purposes of the trial or program. programs in

Australia are the single most effective thing that we could do to change and improve the lives of heroin users...

Heroin is illegal in Australia in large part because Australia, back in the 1960’s agreed to sign the Single Convention. The Single Convention is an international treaty governing the production, manufacture, exportation, importation, distribution of, trade in and use and possession of narcotics including opium, coca and cannabis. The Single Convention is overwhelming in both length and intent and its size precludes a lengthy discussion of all aspects of its reach in this article. If you would like to take a closer look at the detail of the Single Convention and its implications you can find the convention in full at http://www.incb.org/e/conv/1961/ The Single Convention rules everything to do with opium-based drugs in Australia. It has been ‘front and centre’ in the discussions and debates over the heroin trial because among other things it governs: • How opium poppies are grown and processed in Tasmania

including ensuring that no other method other than the straw poppy method can be used. • Requires Australia to provide statistics and detailed information every year on what has been produced, how much has been produced, how much land has been used for opium cultivation, what stores of medicinal opium we have, how much is being used by the local health sector, how much is exported and to whom, what mechanisms we have in place to prevent diversion to the illicit market, etc, etc. • Requires Australia to make a comprehensive and very convincing global case if we wanted to change any of our opium manufacturing, exportation or importation arrangements from the way they currently operate. • Has the power to at least humiliate Australia internationally and ultimately, bring us before the United Nations and ruin the Tasmania Opium Poppy Industry if we decided to ignore the Single Convention. • Requires Australia to, at the national level, make arrangements for prevention and repressive action against the traffic in illicit drugs, to campaign against illicit drugs, to co-operate internationally in the campaign against illicit drugs and to provide information relating to illicit drug activity within our borders, including information on illicit cultivation, production, manufacture and use of illicit drugs. • Requires Australia to prohibit the production, manufacture, export and import of, trade in, possession or use of any drug covered under the convention. Importantly, however, while the restrictions of the Single Convention have on the one hand been used to prevent a heroin trial in Australia, the convention also has the capacity to allow for heroin trials in Australia under certain specific circumstances. The convention states that... “A Party shall, if in its opinion the prevailing conditions in its country render it the most appropriate means of protecting the public health and welfare, prohibit the production, manufacture, export and import of, trade in, possession or use of any such drug except for amounts which may be necessary for medical and scientific research only, including clinical trials therewith to be conducted under or subject to the direct supervision and control of the Party.” Single Convention 1961 Although the above statement is written in legalise, what it says in effect is that should the Federal Government of the day decide that it is in the best interest of the public health and welfare of Australians to run a heroin trial, the convention would allow the government to do so legally providing it was run as a proper scientific clinical research trial and was subject to the direct supervision and control of the Federal Government.This brings us back to where we began. It is possible to run a heroin trial without Australia breaching its agreements under the Single Convention but it requires the current Federal Government to: • Recognise the heroin trial as a proper medical/scientific clinical research trial according the definition in the Single Convention;

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• Be willing to support any necessary changes to legislation to allow the practical aspects of the trial to proceed eg the importation of heroin for trial purposes; • Be willing to undertake the required level of direct supervision and control in relation to the trial that is required under the Single Convention.

arguments ‘in the nicest possible way’ to all ‘the right people’ who promptly promise us little and deliver even less. It is time to make some real noise about this very real issue. We have lobbied earnestly but politely through all the ‘appropriate’ channels to the point of physical exhaustion. We have ‘found the right set of words’ (read self-censored) to describe what we want until our words no longer mean anything. Despite all our efforts we have move absolutely nowhere on this issue and if anything, I suspect that unless something major changes soon, we are set to lose even more ground in the future.

To add to this, for a heroin trial to succeed in Australia there are a number of other less tangible factors that would also have to be present. These include: • Support for the trial by a range of key stakeholders including the police, the medical establishment, family advocates, the media, etc. • Harmony between the various political parties and governments particularly if the federal government and the state/territory government where the trial would be located aren’t of the same political persuasion. • Depending on the size and relative power of the state or territory wishing to run the trial they may or may not need federal government funding support for the trial; • Territories, unlike sovereign states, can have decisions made by their legislative assemblies overturned by the Commonwealth Government. Any decision by a territory to run a heroin trial therefore, would also need to get assurances from the federal government of the day that they would not overturn the decision of the particular legislative assembly.

Time is running out for the people who need this trial most. Too often we hear that heroin trials and programs are just for the minority of ‘hard-core’, ‘hardup’ drug users who have ‘failed’ all other forms of treatment. I believe that it would be an absolute travesty if ever we were able to get a heroin trial in this country and we restricted it to people that are considered ‘at the end of their rope’. We have seen the incredible improvements in quality of life and social functioning that overseas heroin trials and programs have delivered. Why on earth would we want to make ‘failure’ the requirement for being able to get on a heroin trial or program. Wouldn’t it make more sense to encourage as many dependent heroin users as possible into this far safer and legal environment?

As you can begin to see, the number of legal and environmental factors that were needed to make the ACT Heroin Proposal succeed was enormous and it is to the great credit of those involved in proposal that they came so close to success.

So where to from here? It is easy to feel beaten down and demoralised when it comes to the issue of heroin trials in Australia. As a long-term user I can say without any doubt that heroin trials and eventually heroin prescription programs in Australia are the single most effective thing that we could do to change and improve the lives of heroin users. The opportunity to participate in a heroin trial would absolutely transform the lives of many opiate dependent people. Finally, we would be able to live a full and multifaceted life, the sort of life that most people in Australia take for granted, instead of merely scrapping an existence. For some users, a heroin trial will quite literally make the difference between life and death. Do you think that sounds too harsh or too extreme? Well I would say to you that I cannot imagine saying anything too harsh or too extreme on this issue if means that people will finally get off their comfortable, middle-class behinds and actually do something to make heroin trials a reality in Australia. In my opinion, too much time has already been wasted preaching to the converted, making our

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You don’t have to be unemployed, homeless with the ‘seat out of your pants’ to have your quality and quantity life reduced by illicit heroin use. Many regular heroin users who are working, have families, etc, could greatly benefit from being on a legal heroin prescription trial or program. I’ve always wondered how the powers that be would be able to find an objective measure of ‘failure’ against which they could judge whether you were heroin trial material or not. How bad is bad enough for a heroin trial I wonder? And do we really want to wait until people reach that point before we give them what they really want and need to have a real life? I ask you, what sort of world are we living in that these issues are serious discussed? I don’t profess to have all the answers about how we get a heroin trial in


Australia if I did, I’d be out there making it happen so I could finally have a chance at a real life. What I have realised however, is that the time has come to make the issue of heroin prescription the issue that needs to be addressed in relation to illicit drugs not an issue or one of the many issues on the agenda. I think that I must have been asleep at the time, but at any rate, somehow without me really noticing it, the agenda shifted away from heroin trials to safe injecting rooms. As far as I’m concerned, safe injecting rooms are not as important as heroin trials. Safe injecting rooms cannot deliver the sort of quality of life changes that users desperately need. Don’t get me wrong, they are important in their own way but they are not the most important strategy that we should be focussed on.

sure what we are meant to be afraid of - things are as bad as they can get! Dependent heroin users are already living in fear of their very existence. Users are not afraid of real public debate on this issue in fact, many believe that this is precisely what has been missing to date.

I don’t want a safe injecting room instead of a heroin trial. Most injecting drug users will never even use a safe injecting room. For too long we have let other agendas get in the way and cloud the real issues. We live in a democracy where we should, theoretically at least, be able to let our politicians know that we want heroin trials to proceed in this country, provide them with the evidence, show them that they work and reasonably expect that they will carry out our wishes.

We can’t be satisfied with occasional public discussion and newspaper coverage of this issue. While these strategies are important, on their own they will not result in political action. It must be put high on the political agenda of all levels of government. I call on every person reading this article to convince at least five other people of the need for heroin trials in Australia and then, call on those people, to not only do the same, but to also put the issue on the agenda of their state and federal members of parliament.

On issues of real significance the Australian population has never been backward in coming forward and telling our politicians want we expect to be done in our name. The time has come to let our political leaders know that we are not happy with the decisions so far on this issue. We are informed and we have the scientific evidence to support our claims. The report developed as “Stage One” of the ACT Heroin Trial Proposal showed that 66 percent of the general public, 71 percent of service providers and 76 percent of current and ex-users thought that such a trial should go ahead. Governments are routinely elected to office with less public support than this and dare to claim a mandate!

There is no easy road to getting heroin trials in Australia. It is going to take nothing less than a great deal of hard work and commitment. We have to build a ground swell of public and political support layer by layer. We have to get to the point where politicians can’t afford to ignore this issue. How do we get there? Well, one thing is for sure, we don’t get there by deciding that it is all too difficult. We do get there by deciding as a community that the price we are currently paying for not having a heroin trial is way too high and simply unacceptable.

Everyone with an interest in this issue has a responsibility to make sure that it is on the top of the public agenda. I am sick of being told that we should just lie low and don’t draw attention to ourselves or our issues. I am not

We need parents and friends of users and those who support Australian heroin trials to demand the attention of their parliamentarians on this issue. Politicians need to be hearing as much information as possible about heroin trials and their success overseas. Drug users cannot address this issue on their own and they cannot wait another ten years for it to find its way onto the public agenda again of its own accord.

by Ruby Red

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received a phone call from a young girl who had recently been diagnosed HCV positive while in the care of one of our state’s residential rehab programs. She was advised to call the Hepatitis Council but as it was a little late in the day no one was there, so she called me. The conversation went along the lines of “Hi, my name is “Jane” and I am staying at the “Time Out” rehab service. I just had my hep C test results back and I just found out I have hep C. What do I do?” Then I did the “don’t worry it’s not a death sentence, I have it too, I’ve had it for years, blahdy blah blah” and found ourselves engaged in good conversation. I think I had reassured her a little and gave her some information that she was wanting, and after about forty minutes or so we talked about me coming for a visit to give her some resources and talk a little more. As I mentioned, I have spent time in rehab myself and I know how precious a visit from the ‘outside’ can be. This happened on a Friday evening. On the Monday morning I gave the rehab a courtesy call to inform them of the conversation I’d had, and to make arrangements to visit sometime in the coming week as I had promised I would. I introduced myself something like this: “My name is Paul Gill and I am the Hepatitis C Peer Education Worker at WASUA. I am HCV positive myself and one of my roles is to provide support and information to people who have been diagnosed with HCV. I spoke to one of your residents, “Jane”, on Friday night and I am calling regarding the possibility of visiting her sometime this week to give her some information and discuss her situation.” It was no easy task getting to talk to the right person. After being put on hold half a dozen times and speaking to half a dozen people, I finally was told I could speak to “Jane’s” counsellor. She answered something like this...

he tale you are about to read is true. The names have been changed to protect the guilty! When even the state government places value on peer education and support, delivered from drug user organisations, I believe it is high time that abstinence based residential rehab programs are dragged kicking and screaming into the current century. I am employed by my state drug user organisation, which has a contract with the WA Health Department, to provide support and information to drug users about hepatitis C. I am a current drug user and HCV positive. I have also been through periods of abstinence and have been a resident in a twelve step based rehab, so I am well aware of the policies and guidelines governing such places. I must add, I have total respect for such beliefs and people who adhere to them. Anyway, on with the story... I was working back quite late one night at the office, when I

“Hello, how can I help you?” Again I went through my, by now, well rehearsed spiel: “My name is Paul Gill and I am the Hepatitis C Peer Education Worker at WASUA.” “Oh” she replies. “So you’re a volunteer struggling with your recovery and you’d like to visit one of our residents?” “I beg your pardon?” I say, quite startled at her presumptions. “I said, you’re still struggling with your recovery. You do still use, don’t you?” (She was obviously well aware of our proper definition of who is a “peer”!) “Well, um... “ “Yes, I thought so, you do understand that we are an abstinence based program and we can’t have people coming down here putting our residents in jeopardy. We take this very seriously you know!” “Well, I um... I’m not a volunteer.” I blurted out. (by the way I have total respect for vollies and don’t mean anything by saying that, it’s just that, well I’m not one!) “Yes, well like I said, we can’t put our residents in jeopardy after such a short time ‘clean’.” (she had been there for two months!) “So I can’t come visit” I spat, somewhat regaining my composure. “No, you may write a letter if you wish” she condescended. “Well, I’ll do that. If, you give me the reassurance that you will tell “Jane” it is your decision to not let me come here and not mine!”.

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I asked the Hepatitis Council worker who had made the visit how the visit went and how the girl in question was. “Well,” she said, “she didn’t really have a lot to say. She thanked me for the information but didn’t really talk much at all. I don’t think she felt too comfortable. I wonder if you were the one she really wanted to talk to.” “Yeah, I wonder!” I added. Well it’s now a couple of months down the track and we’ve (WASUA) been given an informal apology from the rehab concerned, but it still leaves me feeling quite bitter. I know at first, my reaction was purely ego driven and initially, my anger was at the lack of respect shown to my organisation and me. However, after a short cooling off period I was angry for “Jane’s” sake. Maybe she didn’t feel comfortable talking to the other worker, because it was face to face and did not have the anonymity of the telephone. Maybe not. I think though it probably comes down to the fact that even though I was a worker at an organisation that she was looking for information from, I had three things in common with her that the Hepatitis Council worker did not. I had been in a residential rehab program, I was a drug user and most importantly, I was also hep C positive.

I hung up. I still don’t know how I felt after the conversation, but I will say, I have not let so many cusses and swear words past my lips for a long time! I stormed up and down the hallway (as I am wont to do from time to time) and my manager cautiously approached me. “Is everything all right?”

I have a lot of respect for Bill Wilson’s Twelve Steps and A.A. and N.A. and rehabs. I spent a good two years of my life “struggling with my recovery” and I learned so much about my self during that time that I would not swap the experience for the world. In fact, it was probably those two years that allows me to function as a productive drug-using member of my drug user organisation. I would never ‘jeopardize’ anyone’s attempt at living his or her life drug free if that is his or her goal.

It clearly wasn’t, but I think he was hoping for a quick “NO!” so he could hide back in his office! I baulked at telling him right there as I thought I was too angry to properly articulate what had just transpired, but I started to tell the story from the Friday before. I talked it over with him and calmed down. He became angry too, after hearing my story and assured me that something would be done about it. Satisfied that it was an isolated incident with a particular counsellor I set out to send the biggest package of information I had ever sent. I sent tapes, books, pamphlets, you name it! I sent it! Now, I have since found out, that after my conversation with “Jane’s” counsellor, she had phoned the Hepatitis Council. She asked if someone from there could come down and visit and provide a similar service to the one I had offered. I know the person who visited and I like and respect her very much. I know she would have given first-rate information, delivered in a compassionate and caring manner. Still feeling powerless and ineffectual, I felt the least I could do was follow up and see how she was getting along, albeit from afar.

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However, I am the only ‘peer’ hep C support worker in the state. A peer worker is employed for the life experience that he or she brings to the role. It is due to my experience that I was given this position, yet it is this same experience that has prevented me from doing my job. If this sort of discrimination is levelled at another worker because of their drug use, then what hope do drug users accepting treatment from these people have? by Paul Gill Hepatitis C Peer Education Worker, WASUA For up to date information on hepatitis C that has been produced by drug users for drug users contact your local drug user organisation. For the contact details of your local drug user organisation see the back cover of this issue of Junkmail.


aking the decision to go into detox can be scary particularly if you are not sure what is going to happen, how things run and what meds, if any, will be on offer. While each detox service has its own way of operating and some offer medicated programs and some do not, this article by one Canberra user gives you a sense of how they found the medicated detox program that they went to and also gives you some more general information about making the decision to go to detox... I had been living at Havelock house a supported accommodation service for two weeks. At Havelock I was in a five bedroom unit. Three tenants were heavy drinkers and one fellow was a user. After two weeks of constant drinking [going on] I had, had enough. So I rang the detox in Woden in the morning and had a phone assessment during which they ask you questions such as “How long have you been using”, “What have you been using”, “How much do you use a day” and “What are your plans after detox”. I told them I had been using a quarter a day for six weeks and that I didn’t know what my plans were after detox [truthfully]. I then rang the next morning and was asked to be there by 1pm. So I went and borrowed $20 off a mate and went to go and get on. I arrived at the detox at 1pm and had my ‘obs’ done [obs = observation], this consists of temperature, pulse, blood pressure, blood test and blood sugar glucose test. Then I was shown to my room which was part of a two bedroom unit with a shared bathroom. In my room was a single bed, cupboard and a chest of drawers. After I was settled I signed some paper work saying that I was admitting myself to the detox. Then I got to see the doctor who asked me which one of the three regimes I wanted to go on. The first option was Physeptone, a 5mg methadone tablet, dosing was four on the first day, three on the second, two on the third and then one on day four. The second option was Buprenorphine but I don’t know how this was administered. The third option was Deloxene and Valium, which was administered 800mg and four valium on day one, 600mg and three

valium on day two, 400mg and two valium on day three, 200mg and one valium on day four, 100mg of Deloxene on day five. This is the regime I chose because I had done this previously. I was surprised that from day one the medication helped me to get eight hours sleep a night. Also available were ‘symptomatics’ which are things like Buscopan for stomach cramps, Quinine for muscle cramps, Ibuprofen for all over aches and pains, supposedly there is Temazepam for sleep, and so on. I just used Ibuprofen for aches and pains. There are meetings at the hospital and sometimes people come to drive you to outside meetings of either NA or AA. On Thursday there is the only compulsory group which outsiders attend as well. It is called “Relapse Prevention” and consists of finding and naming your triggers. Triggers are the things that set you off, like thoughts, feelings environments and situations which make you think of, feel like using and how to avoid or deal with them. I found there was plenty of literature to read about using, including stuff about rehabs. All there is to do besides reading is craft, TV, smoking cigarettes, sleeping and socialising. Plus you have the nurses there 24/7 to talk to. And sometimes, a nurse might take us for a walk, usually to the local shops. All in all I found detox was a safe environment that you can just chill out in and think of how to quit or just take time out. The maximum stay is seven days but they would prefer if you stay a minimum of five days. I hope that my detox experience can be useful to other users who are considering going to detox themselves. by Anonymous

Update on Federal Government Activities:

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n Issue 3 of Junkmail we carried an important article about how the Federal Government had announced that it was planning to spend $27.5 million over the next four years on the development and implementation of retractable needle and syringe technology. In that article titled “Ain’t Broke Don’t Fix It”, we outlined the background to the Government’s decision to fund the retractable needles & syringes initiative and highlighted some of AIVL’s major concerns with retractable needles and syringes. This article was back in April last year, however, and quite a lot has happened in relation to retractable needles and syringes since then. Because of the enormous impact that retractable needles and syringes could have for injecting drug users, Junkmail is committed to keeping drug users up-to-date on where the Federal Government’s initiative is up to and informing users of the work that AIVL is doing to represent them on this issue. The following article updates readers on the latest in relation to retractable needles and syringes... Since the first Junkmail article on retractable needle and syringe technology back in April 2002, the Federal Government has done the following in relation to retractable needles and syringes... • Developed a “Retractable Needle and Syringe Technology Implementation Plan - Phase One” which outlines what the Federal Government is planning to do in relation to retractable needles and syringes. This implementation plan includes: - a national consultation process - an Implementation Reference Group to guide and advise - a pilot phase to ‘test’ various retractable needles and syringes - a research phase to investigate a range of issues including data surveillance activities, social & behavioural issues, etc. - an evaluation phase to look at all of the data and information gathered during the first phase and determine the process for the second phase. • Carried out the National Consultation Process including a meeting with state and territory government representatives, stakeholder forums in each capital city with separate meetings for the main stakeholder groups - healthcare workers, injecting drug users, diabetics and industry representatives. • Had a face-to-face meeting with the AIVL President and Executive Officer on the issue of retractable needles and syringes and the government’s implementation plan.

Update on the work of AIVL: Since the first Junkmail article on retractable needle and syringe

technology back in April 2002, AIVL has done the following in relation to retractable needles and syringes... • Met with various federal politicians to discuss concerns about retractable needles and syringes from the injecting drug user perspective. • Presented to the Federal Parliamentary Inquiry into Drug Abuse on drug user concerns in relation to retractable needles and syringes. • Presented at numerous conferences, national meetings and forums on the concerns of drug users in relation to retractable needles and syringes including 3rd Australasian Hepatitis C Conference, ANEX Conference, etc. • Held a major session at the AIVL Annual General Meeting to discuss the AIVL position on retractable needles and syringes and the issues that needed to be raised at the state/territory forums. • Agreed to a brief presentation from “Unitract” (a company currently developing a retractable needle and syringe) at the AIVL Annual General Meeting. • Continued to liaise with the HIV & Hepatitis C Section of the Commonwealth Health Department who are responsible for implementing the Federal Government plan on retractables. • Developing partnerships with other organisations on the issue of retractables so that AIVL is not working on its own and has broader support for the positions it is taking; • Begun the development of the AIVL submission to the Commonwealth Government on retractable needles and syringes.

Summary of Issues from the National Forums: The national consultation forums held in each of the states and territories during November and December 2002 were well attended by the local drug

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user organisations, AIVL staff and AIVL Executive members. Given the potentially negative impact of retractable needles and syringes on lives of injecting drug users, AIVL and its member organisations have taken the task of representing drug users at the national forums very seriously indeed.

• Concerns that companies developing prototype retractable needles and syringes may be more motivated by profits than health needs of those who will be forced to use them; • That injecting drug users should have a choice about which injecting equipment they use not have one form of technology forced on them when the current technology is effective;

Some of the major issues raised by the drug user representatives at the national consultation forums included: • Concerns that users may feel forced to reuse or share the currently available fits if they don’t like the new retractable ones; • Concerns that retractables may lead to more injecting of others particularly if people struggle to use the new retractable technology and get people to help them to inject; • Concerns about the acceptability of retractables to users with vein problems, therefore leading once again to more reusing and sharing of the current fits; • Concerns about the risk of black markets developing in the current fits if people don’t accept the new retractable fits; • Concerns about possible increases in blood borne viruses including hep C and HIV; • Concerns about ethical issues in relation to possible trialling or piloting retractable needles and syringes eg. forcing people to use a particular type of syringe/removing people’s choice of equipment, restricting people’s access to a proven means of preventing blood borne viruses, etc.; • Concerns that retractables may not address the problem that they are being brought in to fix, that is, unsafe disposal. There is a fear that some users might think that it is actually safer to leave retractables lying around publicly because the pick is retracted and this could lead to more, not less, unsafe disposal; • Concerns that retractable needles and syringes are being brought in unnecessarily as the current fits are effective and users are familiar with them; • Concerns that drug users will need to learn a whole new set of safer injecting practices and behaviours to ensure that retractables do not result in increased harms to drug users; • Concerns about the high cost of retractables compared to the current fits and the potential waste of health resources - the NSPs could potentially cost a great deal more to run; • Concerns that the time allowed for the piloting or trialling of retractables will not be sufficient to show the real health and social impact of this technology on drug users particularly if there is any increase in the transmission of hepatitis C or HIV as this may take 3-5 years to be accurately reflected in the public health surveillance figures;

• The need to have AIVL representing injecting drug users on the Implementation Reference Group that the Federal Government is going to be setting up in 2003 to oversee the implementation of Phase One.

Where To From Here? The concerns and issues outlined above are just a few of the issues that were raised at the National Consultation Forums. As stated above, the next step on this issue is for AIVL and the local drug user organisations to develop written submissions to the government to make our voices formally heard on retractable needles and syringes. Once AIVL’s submission has been sent to the government, it will be uploaded onto the AIVL website so it can be easily read by drug users across Australia. Given the significance of this issue, we will continue to provide a regular update on retractable needles and syringes and where the government implementation plan is up to in each issue of Junkmail. In the meantime, Junkmail welcomes articles and letters from drug users telling us your views and thoughts on retractable needles and syringes and their potential impact on your life. by AIVL Policy Team

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Thomas DeQuincey’s Confessions and the Origin of Addiction his facinating article was first published back in March 1992 as a feature in the original Junkmail magazine. Between 1990 and 1992, AIVL managed to gain funding to establish and publish a new drug users magazine called “Junkmail”. Unfortunately, due to the lack of continued funding, Junkmail ceased to be published for the rest of the decade. When AIVL received government funding to produce a national drug users policy magazine in late 2000, it seemed obvious that the magazine should be called “Junkmail” and continue in the proud tradition of the first national users magazine all those years before. The limited funding for the original Junkmail also meant that the print run was small and very few people ever got to see, let alone read or collect those amazing first issues. In order to get some of the best articles from the original Junkmail magazines out to a broader readership we have decided to re-print “Writing Junky” in this issue. “Writing Junky” is an amazing analysis of the origins of the terms “addict” and “junky” which are both central to the way we perceive and describe injecting drug users today. This article, which was originally written as part of David Herkt’s PhD thesis, is a must read for anyone who is interested in challenging the way that drug Our conception of the addict or junky has its origins in 1820. It can be quite precisely dated. By 30th September 1821, all the conceptions that make up our paradigm of opiate use and dependence, and our idea of the opiate user, the addict or the junky, had been put into general circulation. The remainder of the nineteenth century saw a working-out of this paradigm with regard to both medicine and law. The individual responsible for our conception of the junky or user was Thomas DeQincey. DeQuincy was dependent on laudanum for 52 years. Therefore, with regard to the conception of drug use that he developed, DeQuincy can be considered the first junky. He was a writer and through his writings in his particular book, Confessions of an English Opium-Eater, DeQuincey delineated many of the features of that model of dependence and opiate use that remains current. Most influentially, DeQuincey brought the attention of the medical profession to the idea of opiate dependence for the first time. He documented that syndrome that we now know as withdrawal, and he also brought opiate tolerance and opiate dependence to the notice of the medicine. DeQuincey was also utilised by nineteenth century medicine as their major case study, because of his extensive descriptions of his physical relationship to laudanum. While many historical writers have outlined DeQuincey’s importance, his centrality in any discussion of our conception

of opiate dependence and stereotypes of the opiate dependent, has not yet been fully acknowledged. For us, it is as if opiate dependence always existed. Without a beginning, it is as if our conception of opiate use and opiate users is the only conception there has been and can be no other. The origin of the concept that we refer to as opiate dependence has been very little examined. For medicine, in particular, given the fact that its conception of opiate dependency is strongly connected to a government policy of drug prohibition, this origin might provide certain problems. For if there are other conceptions of use and users that are possible, the basis for the current prohibition is put in doubt, along with the livelihood of those who are employed by its supporting services and its bureaucracy. The early nineteenth century is critical in any examination of the origin of our concepts of opiate dependence and those who are opiate dependent. Given the fact that we see opiate dependence as a medical and legal matter, it is surprising that those individuals who had the greatest influence on this origin were a poet and a writer. Perhaps this should not surprise us though, for, as can be demonstrated, this origin is an event that occured in ideas and was the success of a certain description of the world. DeQuincey was substantially influenced both in his writing and his personal life by Samuel Taylor Coleridge. Coleridge is regarded as one of the great poets of the nineteenth century. His poems include The Rime of the Ancient Mariner, and more pertinent to the subject, Kublai Khan. Coleridge, in his preface to Kublai Khan (“In Xanadu did Kublai Khan/ a stately pleasure dome decree...”) states that, in 1797, he had taken a dose of an anodyne (an opium-

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tincture which was called laudanum) and fallen into a half-drowse during which he dreamed the poem. When he woke it was with a perfect recollection of the poem and he began writing the lines down. However, he was interrupted by a visitor and when he returned to his page, he discovered that he had forgotten the remainder. The fifty-seven lines he wrote before the interruption are all that survives. Coleridge was dependent on laudanum from approximately 1797 to his death in 1833, for approximately thrity-six years. It seems strange to say, but Coleridge did not know of his physical dependence at all. Opiates were freely available at that time and were totally unregulated. It wasn’t until the middle of the century that any form of regulation was imposed on sales or use. Opium could be bought from the corner grocer, pharmacist or apothecary, or from door-to-door salesmen or street merchants. It was routinely used as an analgesic, as a calmative and a sleeping draught. It was also used for pleasure in many of the larger factory areas. Grocers and apothecaries put out additional stocks of wrapped opium pellets for Saturday nights as it was cheaper than gin. There were areas of England where use was widespread and constant, particularly the Fens. As a consequence there must have been large numbers of individuals who were opiate dependent, but had never discovered it, having never had to go without it.

Thomas DeQuincey was born in 1785 in Manchester, the son of a merchant. He had literary ambitions and made serveral attempts to meet Coleridge. However, it was not only an interest in writing, poetry and philosopy that they had in common, for by the time that DeQuincey met Coleridge in 1807, he had already begun his career as an opiate user. The patterns of opiate use, prior to the institution of laws against he use of the drug, must be of interest to us. Neither Coleridge and DeQuincey had restrictions on their consumption and no formal bounds to their usage. There were no social, medical or legal restrictions on use. DeQuincey referred to the years 1804-1812 as his years of “practicing” opiate use. In 1813, an “irritation” of his stomach was responsible for him raising his dose to 340 grains of opium or 8000 drops of laudanum a day (“a formidable figure”, writes A.H.Japp, DeQuincey’s first biographer, though we learn that it is only a little more than half of what Coleridge was taking at the same time.”) It was during this period, in which DeQuincey attempted to control his increasing tolerance, that he constructed, by connecting the effects of opium on his own body, a model of dependence which, in essence, is substantially the same as our present conception.

It was the years 1818-1819 that De Quincey found himself customarily using large amounts of laudanum. This period was seminal for his writing of the Confessions. His “dreaming faculty” was dominant and his state of “nodding-off” produced great Coleridge’s conception of his own use is interesting. dreams and fantasies. “When I lay in bed He was aware that he had a habit, but to him it was vast processions passed along in mournful exactly that, a habit or a custom. Coleridge claimed pomp; friezes of never-ending stories, that that he began taking it for an illness and then to my feelings were as sad and as solemn became accustomed to it. He felt some remorse, Samuel Taylor Coleridge as if they were drawn from the times due to his strong Christian philosophy, that he before Oedipus or Priam - before Tyre was succumbing to a luxury and surrendering to a - before Memphis.” In the Confessions, he writes of this time: “I sometimes pleasure. Then when dependence set in, and he attempted to stop, seemed to have lived seventy or a hundred years in one night... the splendours he found that this cessation was accompanied by physical illness. of my dreams were chiefly architectural; and I beheld such pomps of cities However, Coleridge simply considered that this was the return of and palaces as were never yet beheld by the waking eye, unless in clouds... the underlying illness that opium had served to palliate or to halt. I escaped sometimes and found myself in Chinese houses, with cane tables, The model is clear: Coleridge had an illness, he took opium and etc. All the feet of the tables, sofas, etc, soon becme instinct with life; the the illness went away. When he stopped taking opium, the illness abominable head of the crocodile, with his leering eyes looked out at me...” returned. Coleridge did not associate his symptoms with anything DeQuincey speaks of these years “set as it were, and insulated in the gloom resembling withdrawal as we know it. It is pertinent to note that and cloudy melancholy of opium.” Coleridge demanded that his body, after his death, be autopsied to discover this basic illness that had seemingly so bedevilled his His regaining control of his dose and his life resulted in his literary success. existence. DeQuincey was the first of a long line of individuals who utilised their drugtaking experiences as the basis of a career or a successful best-selling book. Coleridge was famous in England at that time for his writing and Confessions of an English Opium-Eater was serialised in two parts in the London his personality. To us now, some of the descriptions of Coleridge’s Magazine for September and October 1821. In the nineteenth century these shining face and bright eyes and interminable monologues describe monthly magazines were extemely popular, providing to their subscribers with some characteristics of opiate use. He was very much respected for sophisticated commentary on contemporaneous events, intellectual discussion, his intellect and his personality and was the object of attentions of reviews, fiction and vivid opinion. Confessions created great interest and it young writers and “intellectuals” of the time.

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was reviewed well. As a result DeQuincey began selling other contributions to such magazines and he became a famous figure in London, being sought-out for interviews and dinners. Confessions were reprinted in book-form in 1882. The book is fascinating when viewed from our later perspective. DeQuincey describes his opiate use in the preface to the book: “If opium-eating be a sensual pleasure, and if I am bound to confess that I have indulged in it to an excess not yet recorded...” DeQuincey’s recording of the event and the manner and content of this recording were crucial to the development of a conception of opiate use. He told of his usage of opiates in sensational detail, but he placed it in the context of his life, as providing the key to him becoming an opium-eater. This connection is important.

hopelessly, with increasing anxiety, for a young woman in great phantom cities with endless streets. Part two of the book describes his discovery of opium. After an illness consisting of “excruciating rheumatic pains of the head and face”, a friend recommended him opium. It was a wet cheerless Sunday afternoon in 1804 and the sudden transition caused by the drug, as discovered by innummerable other users on their first encounter with opiates, was a wonderous experience. The pleasure of the drug was amazing to the nineteen year old as was the new world that opened up to him. Over the next months he began to repeat the pleasure. He would use it every three weeks, usually on a Tuesday or Saturday night. DeQuincey would take his laudanum and simply wander through the city, exploring the maze of London streets, watching the faces and following the crowds. The next chapter heading in the Confessions was entitled “Introduction to the Pains of Opium”. In the period between 1804 nd 1812, he had continued to use the drug but at intervals and for short periods. An illness in 1813 caused him to take larger amounts, with more frequency until, taking the drug on a daily basis, he developed his first habit.

Prior to DeQuincey, an opium habit, if it was noticed at all, was a simple behaviour with no more relevance than any other habit. The situation of DeQuincey’s opiate use in his life created the paradigm whereby opiate use has been seen, not as a behaviour, but a a result of a whole process of life. Currently it is this paradigm that has led to opiate use being seen as a result of an individual’s upbringing or character.

Living at the time in a small cottage in the Lake District, he began to experience the full effects of constant use, allied DeQuincey’s story as told with the large doses he was in the first version of the then using. He experienced Confessions, tells of his action “a sympathy that seemed to of running away from school Thomas DeQuincey - he was our first junky. He discovered arise between the waking and in 1802. He wandered over dependence and wrote opiate usage into our culture. dreaming states” which we refer England, through North Wales to as “nodding off”. Because and to London. Then aged of the effects of the opium, sixteen, he avoided all contact the strength of his doses and DeQuincey’s constitutional state of being “a with his guardians until he ended up on the streets of London. dreamer”, DeQuincey experienced long, complex and nightmarish dreams. With scarce financial resources and often hungry, he lived where William Burroughs, the author of Junkie and Naked Lunch, comments upon his he could find shelter. As someone who was forced to live on the own time in Tangier when he could similarly utilise large amounts of opiates streets, he fell in naturally with those women “technically known as daily for a number of years: “One is forcefully reminded of DeQuincey... when Street-walkers.” he describes the gloom, the oppression and feeling of death, brought on by He developed a relationship with one of many Victorian sex-workers habitual over-dosage.” he met, a fifteen year old girl, named Ann. She had taken care From our modern perspective, DeQuincey was discovering, without any of him when he collapsed from hunger, and DeQuincey fell in culturally preordained idea of the drug, the opium experience as we know it. It love with her. After he was recognised by a friend of his family, is a dramatic event. To read his words and transfer those descriptions onto our he made arrangements to see her again, but she did not come own concepts and experiences is a remarkable process. However, it is in the to their assigned meeting and though DeQuincey searched for Appendix to the 1822 book-version of the Confessions that DeQuincey makes her for as long as he could, he could not find her in the maze of his most important discovery, for he describes a syndrome, or a connection or London streets. In his later dreams, DeQuincey was often searching

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a series of symptoms, that we now know as withdrawal. If people do not know what to expect, their experience of the world will not tell them that opiate use causes physical dependence and cessation of that use cause physical illness. Opiate dependence is a unique phenomenon. To claim that stopping opiate use ‘causes’ this illness is a discovery that had not been made in any of the medical literature of the early nineteenth century. In fact, medicine was almost ignorant about opiates at that time, except for the fact that they were (and still are) the most effective analgesic known. No medical materials in 1820 referred to any aspect of ‘addiction’ or ‘withdrawal’, though it was known that some individuals had a habit of using opiates daily.

...When DeQuincey described himself as “an English opiumeater” he took upon himself an identity as a user, as a ‘junky’. This first proclamation of this identity established a basic pattern for perceiving users for the next two hundred years...

DeQuincey, in the small Appendix to his book, gave his reduction schedule from 24th June 1821 to 27th July 1821, as he attempted to reduce his dose from 130 drops of laudanum to none. He carries out this regimen well, though his relapses (eg: “Monday 8th July: 300 drops”) must be familiar to anyone who has attempted this selfimposed schedule. But simultaneously, DeQuincey notes and describes his symptoms.

on 20th September 1822, Thomas DeQuincey provided the information that enabled the construction of the opiate experience, much as we know it today. The story of a boy who runs away from school, hitchhikes around the country, hits the streets of a large city where he becomes a street-kid, hangs around with sex workers, and develops a drug habit is a standard story. It is repeated daily in our media, in some form or another. It has nothing to do with the intrinsic nautre of opiates or the type of individual. Rather it can be seen that DeQuincey wrote a paradigmatic case and so influential was his writing, that all medical descriptions of opiate use in the nineteenth century directly utilised DeQuincey’s model and often quoted his descriptions. However, it was not simply medicine that followed DeQuincey. Such was his success that several individuals were brought to the attention of the medical authorities in the 1820’s, because they overdosed in an attempt to followed DeQuincey’s example. Thousands of others would have followed his example without overdose. DeQuincey’s description of himself and his drug adventures created a social construction of use, where any individual using, even for the first time, approached opiate use as already situated in his or her social world, in his or her cultural context. In other words, each of us knowing what to expect from the experience, as a result our experience will follow that path. DeQuincey’s personality, his rebellion, his fascination with dreams and visions, his explorations of the psychic world that opium created for him, were all used to establish a certain type of use and user. This conception of use predominates in our world now, in people who have never heard of DeQuincey.

“Meanwhile the symptoms which attended my case were these: enormous irritability and excitement of the whole system; the stomach in particular restored to full vitality, unceasing restlessness night and day, sleep - I scarcely knew what it was...” He suffered “violent sternutation” (which can be translated as runny nose and sneezing), excessive perspiration and an inability to keep still for more than a minute.

Another symptom was what he called internal rheumatism, which affected his shoulders and joints and which any user who has hung out and ‘kicked’ a habit knows only too well. He also notes: “It’s remarkable that the whole period of years through which I had taken opium, I had never once caught a cold,” (a comment which has been echoed by innumarable users from DeQuincey to Keith Richards and William Burroughs), “but now a violent cold attacked me.”

When DeQuincey described himself as “an English opium-eater” he took upon himself an identity as a user, as a ‘junky’. This first proclamation of this identity established a basic pattern for perceiving users for the next two hundred years. It is of interest to ponder how our perception of users might have differed if it had been another dependent individual of the time, such as the aristocratic Lord Erskine, who was the Lord Chancellor of England, William Wilberforce, the politician and philanthropist, or Dr Isaac Milner, the Dean of Carlisle, who had written such a book. Then, instead of seeing users as rebellious and street-wise, perhaps we would have seen users as being upperclass, conservative men, who had integral roles to play in the nation’s power structure. Thomas DeQuincey and the effects of his Confessions of an English Opium-Eater have had on subsequent history has been immense, but such is the power of discovery and first descriptions, which not only describe, but create. by David Herkt (When this article was written David Herkt was the Editor of Junkmail. This material forms part of David Herkt’s PhD thesis: “Writing Junky: The Creation of Addiction”.)

The list of symptoms to his runny nose to his diarrhoea is the first cataloguing of withdrawal symptoms. These symptoms are also connected causally by DeQuincey, to his cessation of opiates. Thus

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or most users going to the doctor is a very stressful experience. Once someone is a ‘known drug user’, they are treated as if they never experience genuine pain or illness or, if they do, they do not need to be treated for that pain or illness in the same way as other members of the community. Once someone is a ‘known drug user’, every trip to the doctor is viewed with suspicion. As a consequence, many drug users avoid contact with the health system due to fear of how they will be treated. Instead, drug users selfmedicate to manage the pain that the health system won’t treat and spend their lives shopping for a ‘user-friendly’ doctor who will believe them... As a young illicit drug user, I was always terrified of doctors, especially the good old family GP. I guess I had been educated to be in awe of doctors until I came to learn that doctors are human beings who share the same strengths, weaknesses and foibles as the rest of us. Indeed I have been fortunate to meet more than one kindly, understanding and sympathetic physician over the years, but it seems that some sort of barrier or boundary, whether real or imaginary, has prevented me forming a trusting and truthful relationship with a doctor. It seems that I was destined to work my way through the “Medical Practitioner” section of the ‘phone book in at least three capital cities as well as numerous regional centres in search of a doctor I felt I could trust. After thirty-five years of searching, I’ve not managed to find a doctor who is prepared to give me enough time and space in which to engage and relate in an honest and satisfying way. Now, I don’t mean to say that I haven’t trusted doctors from time to time. That would be unfair and far from the truth. I still have my tonsils. I’ve never had a broken bone, nor have I had any serious accident or injury. I have had all the usual aches and pains, childhood ills and adolescent complaints that have been adequately addressed by competent and caring members of the medical

profession. I’ve had a couple of general anaesthetics and a few stiches here and there. I’ve managed to outlast more than one methadone prescriber too. But despite having met some wonderful professionals, I just don’t seem to be able to connect with a doctor with whom I feel totally at ease. Perhaps I just suffer from an excess of guilt? Here I am closer to sixty than fifty, in fine health and with an enormous appetite for drugs. Use them, abuse them, just get as much of everything and anything in me by the most effective and efficient means possible. Needles, noses, sweat glands, any orifice will do. After so many years, I could do with a bit of a tune-up. A good oil change and grease would do for starters, but I just can’t find the right doctor. Perhaps, “in the horns of a dilemma” best descibes the way I feel. In two days I have an appointment with my methadone prescriber. I have seen him regularly for more than eighteen years. I was his first methadone patient. Let me explain. When the local public methadone program expanded, the regular doctor needed to take on another prescriber part-time. I was asked if I was prepared to see “the new chap” and “help him find his feet first day on the job”. No problem. I’m fairly docile... I can string a sentence together without the need to use the reproductive expletive and I appreciate the need to have a methadone prescriber who can meet my needs rather than just being another methadone guinea-pig. It was

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the start of another wonderful symbiotic relationship. He makes me feel good. I think he feels like he’s done a fair job after the ten minute ‘script renewal consultation. He’s in a hurry because the waiting room is full of people needing everything done yesterday and I just can’t bring myself to tell him the “whole truth”. Having used up just about every injecting site available, except my neck and behind the eyeball, and having had a couple of deep vein thromboses, I’d like to discuss with him the fact that my cardiovascular system is just about compromised. But I can’t. I think that he would feel let down; deceived, lied to and perhaps even a little inadequate. Besides, he is there simply to extend my methadone prescription. If I have a specific health problem, I’m obliged to see my usual general practitioner. Now, if I turn up at his surgery and confide that I’m having some discomfort with a nasty lump in a major vein that’s formed a scary lump above a recently used injecting site, I know (or at least I fear) that I’ll be read the riot act. Told I’m too old for this sort of stuff and then have to cop a lengthy lecture on how it’s my own fault, that I’ve done it to myself and do I really expect a referral to a specialist veinologist (is there such a beast?) in order to have some elective surgery done as a public patient in a public hospital to correct a self-induced partial blockage (varicosed vein) as a result of self-administering illicit substances? You’ve got to be kidding mate! The cynic in me suggests that I wouldn’t have a problem if I was in a private health fund. The optimist in me suggests that if I could just establish an honest, no holds barred relationship with a doctor who was vaguely on the same wave-length, I would be more than happy to share a lifetime’s experience of experimenting with chemicals in exchange for a bit of overdue maintenance. To confide in my general practitioner, fine physician that he is, would, I feel, necessitate him conferring with my methadone prescriber and discussing my ‘on-going illicit drug use’. I know my methadone prescriber only too well. His immediate response would be “Hmmm. He’s been injecting his methadone takeaways.” Well sure. I do have the occasional shot of “death and moan”, but I inject heaps of other things too. I just know that the first thing that would happen is no more takeaway doses of methadone and I’ve been in the game too long to have to forego the convenience of three takeaway doses a week. I don’t divert. I don’t inject every drop within minutes of collecting takeaway doses, but I know from the experience of others that as soon as you ‘fess up to having the odd shot or three, the prescriber feels obliged to note your file with comments like: “Presented this day advising still injecting illicit drugs. This contravenes behavioural stability indicators. Recommend suspension of t/a’s for 3/52. Increase random urines to three per month. Recind pharmacy pick-ups. Client advised doses to be dispensed from hospital dispensary until further notice.” This type of treatment I don’t need.

What I do need is a relationship where I can feel comfortable about discussing my concerns without the fear of some form of “adjustment” to my treatment regimen. Do I keep doctor shopping until I find a doctor who can spare the time to take a full history and demonstrate to my satisfaction that there is enough empathy for me to be totally honest, holding nothing back and just taking a chance that I won’t be “crucified” for telling the whole truth and nothing but the truth? Or, should I just shut up, stuggle on and do my best? Perhaps I might add a codicil to my will suggesting my body be donated to a progressive medical school who can have a bit of a look at the internal organs and deduce that a lifetime of chemical experimentation isn’t as bad as the boogie man suggests and maybe we can better educate those bright eyed, bushy tailed young medical students to understand that substance use isn’t really as bad as some educators would have them believe. And, when some burnt-out old reject from the sixties presents with a few complications derived from years of injecting, there’s no need to hit the roof and start lecturing your grandmother on how to suck eggs. For me, a simple objective, non-judgmental approach would do just fine. Maybe if I was confident such a response would be forthcoming, I would have little hesitation in confiding all of the deep dark secrets to just one doctor without fear of retribution, lectures and inappropriate notes being made on my medical record. by Anonomyous

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QUESTIONS 1. What was Keith Richard’s variation on the “mile high club”?

18. Breaking the needle off the fit after injecting is a good way to prevent the spread of hep C. True or False.

2. Who or what did Australian dance music guru Paul Mac thank in his acceptance speech at the ARIA Awards? 3. What did Anthony Kekdis from the Red Hot Chilli Peppers “draw under the bridge”? 4. If you’re intending to inject someone else, what is the first thing you should do before preparing the shot or injecting them? 5. What did 1930’s film star Errol Flynn say about the use of opium and sex in his autobiography “My Wicked, Wicked Ways?” 6. Sex that involves blood can be a transmission risk for hepatitis C. True or False? 7. What is ecstacy sometimes called due to the way that people behave towards each other after taking it?

19. What two drugs were a popular combination for dancers at the famous Studio 54 in New York in 1977? 20. What does the phrase in a Jarvis Cocker song “sorted for Es and Whizz” mean? 21. What is the pharmaceutical name of the drug with the brand name Dilaudid? 22. New hepatitis C infections in Australia have increased by 45% in the last three years from 11,000 new infections per year in 1998 to 16,000 new infections per year in 2001. True or False? 23. Which famous Australian musician had his portrait painted by well known Australian artist/user Howard Arkie?

8. What cocktail of drugs is thought to have killed Jimi Hendrix?

24. Approximately how many ecstacy pills were believed to be consumed in the UK every weekend at the height of clubbing culture in the mid-1990’s?

9. Hepatitis C can be transmitted through the sharing of tourniquets. True or False?

25. What is the difference between being “HCV antibody positive” and being “HCV PCR positive”?

10. Who wrote “Confessions of an English Opium Eater”?

26. The possession of drugs for non-medicinal use was not subject to criminal prosecutions until the twentieth century. True or False?

11. What was Mick Jagger sentenced to three months imprisonment for possessing in 1968?

27. What is the title of Neil Young’s famous song about junkies?

12. Who discovered amyl nitrate? 13. Why is HIV classified as a sexual transmissble infection (STI) and hepatitis C is not? 14. What was the name of the 1975 Bob Dylan album that many believed referred to heroin use?

28. What is one of the best things injecting drug users can do to prevent to spread of infections? 29. Why do some people like using amphetamines like speed and ice before sex? 30. It is safe to recap someone else’s fit. True or False?

15. When was ketamine first synthesised? 16. U.S. research with dependent heroin users showed that 45% of male heroin users in the sample experienced moderate or severe premature ejaculation before heroin use compared with only 12% after heroin user. True or False? 17. In the 1930’s the famous couturier Coco Chanel and the avant-garde art and music patron Misia Sert travelled from Paris to Switzerland regularly to get what?

31. Which country did the majority of opium used in England in the eighteenth and nineteenth centuries come from? 32. Which popular dance drug was tested as a “truth drug” in the 1940’s by the CIA?

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25 19. Cocaine and Quaaludes. 1. He drew attention to himself on a flight to Toronto in 1977 by having a shot in the toilet on the plane and staying in there for three hours.

20. It is referring to having the amount of ecstacy and speed that you want being “organised” or “sorted”.

2. Ecstacy. 21. Hydromorphone. 3. Some blood. 22. True. 4. Wash your hands thoroughly. 5. That using opium greatly enhanced his sexual stamina and performance. 6. True. (Generally the sexual transmission of hep C is considered very low risk. If there is blood involved, however, the risk of hep C infection is much higher.)

23. Nick Cave (the portrait is currently hanging in the National Potrait Gallery in Canberra). 24. One million. 25. HCV antibody positive means that the person has been exposed to the hepatitis C virus (HCV) and in response, their body has produced antibodies to the virus. HCV PCR positive means that the person has not only been exposed to HCV but that the virus is still present and active in the blood cells of their body.

7. The “Love Drug”. 8. Alcohol and benzos. 9. True.

26. True. (Except in a few U.S. cities in the 1870’s.) 10. Thomas DeQuincey. 27. The Needle and the Damage Done. 11. Four amphetamine tablets (although the sentence was overturned on appeal). 28. Always wash their hands before and after injecting. 12. French chemist Antoine-Jerome Balard. 29. To prolong and heighten sexual pleasure. 13. Because unlike hep C, HIV can be transmitted through body fluids that are exchanged during sex including semen, vaginal fluids and blood. Hep C can only be transmitted through blood.

30. False. 31. Turkey.

14. “Blood on the Tracks”. 32. Ecstacy. 15. 1962. 16. True. 17. Morphine. 18. False. (Although it may prevent anyone else from reusing the fit, you end up with a loose, used needle that is difficult to see and can result in needlestick accidents.)

ANSWERS


here are more than 20,000 people on methadone in Australia. And while there are a range of different types of programs and approaches in the various states and territories, there is one thing that seems to ring true for almost every person on the program -dissatisfaction with their treatment. This news is not new. Health services and methadone providers themselves are well aware of the attitudes of methadone users towards the program, but unfortunately changes to the program continued to be thin on the ground. As a way to encourage a broader understanding of what it is like to be on the methadone program in Australia, Junkmail decided to publish the following article written by a current methadone user. This important and very personal article highlights some of the major problems with how the methadone program currently operates and demonstrates how the program’s own rules and regulations often get in the way of people improving their lives. Far from merely cateloguing all the problems associated with the program, the author also makes some suggestions on how the methadone program might better meet the diverse needs of those people who are on it. With more and more people seeking out methadone as a long term maintenance treatment, there is a critical need to ensure high quality, flexible programs that meet the real needs of those on the program and treat each person with dignity and respect. As Jessica’s experience shows, we have a long way to go before our methadone program

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I first went on to the methadone program for all the usual reasons - totally broke, debts all over town, threats everywhere I turned, jumping at every knock on the door, hanging like a dog and completely over the whole f***ing thing... same old, same old. To top it all off I had narrowly escaped being done by the cops earlier that morning and by the afternoon I knew that the gig was well and truly up. It was time to take some action...

...no matter how you actually behave, you are judged as incapable of making responsible decisions and constantly viewed as if you are only one step away from being a gun wielding maniac...

The pathetic state of my mind and life in general meant that by the time I made up my mind to get on the program, I was actually looking forward to the changes that I thought that it would bring to my life. Admittedly, I did try and hang on as long as I could before making the decision to go on ‘the ‘done’ but eventually, broken and demoralised I gave up and gave in. At the time of walking through the doors of the local clinic I didn’t care about the hoops I would have to jump or what I was getting myself into. I was sick and tired and I just wanted someone to make it all go away - or at least make the burning pain in my guts, the aching legs and the hot and cold sweats go away. I figured if I could get something to sort out the physical stuff, it would buy me some time to deal with some of the other issues in the state of utter degradation that was loosely termed ‘my life’. That was the theory anyway...

Ten years down the track I have ‘jumped’, ‘crept’ and ‘fallen’ off the program too many times and I am currently trying to come to terms with the fact that when it comes to methadone, I think that I’m up for a life sentence. Anyone who has been on methadone for a while will understand that such a thought is simultaneously terrifying and an overwhelming relief. It’s not for nothing that the methadone program is called “liquid handcuffs” by most people on the program. It is the same reason why users will do anything to avoid going on the ‘done if they can. Once you’re on the program you basically loose the freedoms and rights that normal people take for granted. You can’t move around freely, you’re either treated like a child or a criminal or both, no matter how you actually behave, you are judged as incapable of making responsible decisions and constantly viewed as if you are only one step away from being a gun wielding maniac. Do I sound a little angry? Well, you bet I am and I am not the only

one. People in general do not respond well to being treated with contempt and why should we? I’m not naive enough to pretend that everyone on the program is as pure as the driven snow, but people do deserve to be treated with dignity and respect. The way the program currently operates, it doesn’t seem to matter what sort of program your on, how long you’ve been on ‘done or what sort of track record you have, everyone is treated in the same way - with suspicion. People aren’t expecting miracles but they do deserve the methadone program to be run properly. Along with a lot of the other people that go to same chemist as me, I hold down a full time job, have kids to look after and I am forced to get to the chemist most days of the week to pick up. This might not sound like much to someone who hasn’t had to do it four days out of seven for the past ten years, but take it from me, it’s a thorough waste of time for all concerned and it adds another stress to the lives of people who could really have done without it. All the government propaganda on the program goes on about methadone being about “normalising” people’s lives. While I have never been too clear on what that means exactly (particularly when I look at the lives of some of the people I know who have never used heroin), if it is about supporting people to hold down a job, spend time with their family, be better with money, not use, etc., I’m not convinced that the way the methadone program currently runs really supports people to “normalise” their lives much at all. Sure, the program buys you some time away from the physical side of hanging out and the treadmill of using all the time and this is really crucial, but I reckon that it could be doing much more than that. Talk to just about anyone on methadone and they will have at least a few horror stories about how they have been treated and they will express major concerns about how the program runs. People go into the program motivated and committed to what they want to achieve, but the program constantly lets them down by not listening to them, not taking their concerns seriously and not helping them to get where they want to get to. At times over the past ten years I feel like I have improved my life despite the methadone program rather than because of it. I have managed to keep my job for the past seven years even though I have real trouble juggling the hours I have to work, with the hours that I can get dosed at the chemist. I have managed to keep the fact that I am on ‘done from my kids even though this is really hard to do when you have to go to pick up four days every week. Not being able to get a bunch of takeaways at short notice or even with notice sometimes has meant that our family can’t just take off for the weekend or go on long holidays like “normal” families do. I’m sure you get the picture. Far from encouraging people to have “normal”, independent lives, the methadone program is based on keeping people dependent on the system. In other countries, people who have been on the program for a while and are considered ‘stable’ can pick up a few weeks doses at one time (this is called “unsupervised dosing”). For those on this type of program it works really well and has not resulted in heaps of methadone overdoses or more people selling their takeaways than places with “supervised dosing” programs. This type of program treats people like adults and encourages people to take responsibility for managing their methadone.

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This is not rocket science. Just about everyone else in the community who are on regular medications are trusted to manage their medication unsupervised. People on methadone want and deserve a program that is able to meet the individual needs of the people on it. The methadone syrup is provided to the clinics and chemists for free by the government and the only cost to them is the costs associated with dispensing it. With few exceptions, people on methadone pay anywhere between $2-$11 a day for their dose and this more than covers the cost of running the program. Despite paying for their treatment, people on methadone are often made to wait until all other customers are served, if they are dosed at a chemist, before the pharmacist will dose them. This is not only humiliating but often leaves people standing in queues for half and hour when they should be at work. People are assumed to be shoplifters, potentially violent and untrustworthy which in turn is meant to justify the use of hidden cameras, mirrors, bars, bullet proof glass, security guards etc. Not surprisingly, being pigeonholed and stereotyped in this way makes people angry and resentful. When you add this treatment together with a totally inflexible program, you end up with people dropping off the program out of frustration or taking their frustration out on people around them. A good methadone program could also offer other support services to people such as counselling, help with job skills, supporting There is no reason why the methadone program can’t be designed to actually meet the needs of the people on the program more. What would such a program look like? Here are just a few ideas... • You would be able to negotiate the number of takeaways you wanted and how you wanted to get them depending on what was going on in your life; • Once you were on the program for a while and going OK you could move to unsupervised dosing; • Urine testing would not be compulsory or used to punish people; • You would be able to get occasional doses of methadone if you didn’t want to be on the program fulltime but wanted to use it to stop things getting out of control; • You would be able to put your dose up and down as you wanted/needed to; • There would be more dosing places so that if you couldn’t get to your regular chemist or clinic, you could get dosed somewhere else. This would be particularly good for people who work long hours or start work very early. • You would be treated with respect and dignity and like any other customer/patient.

parents on the program, assisting people to get into courses, etc. I think it speaks volumes that I have been on the program for over ten years and I haven’t once been offered counselling or any other sort of support. Sure, I am in full time employment now, but when I was at my lowest point, I didn’t get any help from the program to get things together. I was told I have hep C on the phone by a nurse from the program and I had no idea what it was. She didn’t offer me any information and since that, not one of the prescribers that I have had has shown any interest in talking to me about hep C. I have heard that prescribers at some clinics are now giving hep B vaccinations and helping people with their hep C - testing their liver function and stuff like that. I think that this is great and there needs to be more of it! I know that not everyone wants extra services but at the moment most people don’t even get the choice. People are left to deal with things on their own... it’s sort of sink or swim it’s up to you! Don’t get me wrong, there is no doubt that being on ‘done has helped me to pull things together and these days my life is in much better shape than it once was (relatively speaking of course!), but I believe that the methadone program could have played a much bigger role in helping me to get where I am than it has. Once you’re on the ‘done society sort of abandons you. You’re seen as someone who has failed at life - not worth spending any special time or effort on. We just want to be given a fair go and get what we pay for, that is, a good quality methadone program. by Jessica Walker

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could become quadriplegic, paraplegic, or at least permanently loose total control of ones sphincter. I merely lost strength and coordination in my right hand. I suspect that was where the paralysis had decided was as good a place as any to start its “handy-work.” There are a hundred stories to tell, all engendered by this sickness. I only wish to tell one. It is the one where I learned to keep my mouth shut. Yes there were burn victims; in there with me. And I learned that I was not as important as they were. How brave they were. No, not a peep from them, and there I was moaning like a frightened child. My back had to be cut open and the spinal cord debrided; scraped. They left some pus though. Couldn’t get it all. I wondered if I HAD BEEN filleted like a carp! A nurse “couldn’t take my whining one more instant”. No, not a single instant more, not from a junky who did it to himself and then had the nerve (spinal cord, I mean) to bellow like a confused cow. She told me all right yes she did. “Look, there are others here important as you and they don’t whine no, they suffer in silence.” Not like certain self destructive, life-shunning, poisonloving, noisy babies who object, yes object to the price they racked up over the years and now stamp their feet and refuse to pay their debts without complaint, like men.

n mid-October I found myself bewildered by an advancing agony and fever. Soon walking was well nigh impossible and I learned the special terror of being exiled by pain to lying on my back in bed... The initial responses by medical personnel to this drug addicts pain were: a) Toradol at my HMO; and b) Tylenol by one of Boston’s premier hospitals. That was after a six hour wait. The next morning I returned to that hospital in an ambulance. An emergency this time. That was on October 20. I walked out of the rehabilitation hospital on December 8 after two laminectomies, one which entered by way of my throat on route to my spine, six weeks of intravenous antibiotics as well as of intensive occupational and physical therapy. The MRIs revealed two epidural abscesses, one extending over cervical vertebrae 1-7 and the other involving my spine in the lumbar region. I fought all attempts to get me to see a doctor. Too much for a drug user to lose; never know what they’re going to do to you. My instinct for self-preservation almost cost me more than I had bargained for. The text that I consulted pointed out that in a matter of hours (I waited three whole days. I’m very fortunate, to say the least) one

They could not give me much for the pain. With 120 mg of methadone as my usual dose they feared overdosing me with the smallest dose of narcotics. I might stop breathing for Pete’s sake. They gave me a shot of fentanyl every four hours. It would last forty-five minutes and for the other three hours and fifteen minutes I’d scream. Shameless. I started to make sounds like barn-yard animals - there’s nothing more monotonous than unremitting pain. Sheep. Goats. Chickens. Horses. To keep my mind firmly in this world. A lot of us; yes, this happens to a lot my friends. Some have died without a peep. First they get a bone infection. Next come the abscess. Junior, for example. His legs went. He couldn’t walk. A year later he died. Frank and Cookie. They lived. But Frank never goes out. He walks like his shoulder has been sown to his hip. Those who use their necks seem to get infected cervical vertebrae. Cookie wore one of those haloes that screwed into her head. She’s OK now. Methadone is so confusing for the nurses. It should kill our pain but it doesn’t. “They should need less but they say they need more.” So they get mad at us. We have to be lying. After all we are renowned as expert liars. Some of the best. I must be lying about the pain. Nothing hurts but I just don’t know it. That’s what good liars we are. I’ve even put one over on myself. Pretty damn amazing, huh? Someday it’ll all make sense. Have hope.

by George (U.S.A.)

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Importantly, in terms of showing the positive impact of NSPs on the lives and health of drug users, the report also compared HIV and hep C rates in cities with and without NSPs. It showed that cities with NSP had an average annual decrease in the level of HIV infection of 18.6 percent while cities without NSP had an average annual increase in the level of HIV infection of 8.1 percent. In relation to hep C too, the study showed a decrease in the levels of hep C following the introduction of NSP. With each new hep C infection costing the Australian health system an average of almost $40,000 in treatment costs, NSPs have saved significant health costs for the Australian community. Although many government reports of this type can seem to be full of meaningless statistics and information that is virtually indecipherable to the average person on the street, this study demonstrates the real value of NSPs in a very straightforward way - NSPs save lives and prevent disease. It is a simple and straightforward message that shows categorically that since the time that they were funded to the present day, NSPs have more than delivered all of the health and social outcomes that they were funded to provide. njecting drug users are aware of the value of needle and syringe programs (NSPs) on a very practical level - they provide us with clean injecting equipment so that we can avoid HIV, hep C, hep B, dirty hits and abscesses just to name a few. A recent report commissioned by the Commonwealth Department of Health & Ageing, however, has for the first time been able to show the rest of the community why NSPs have been a good investment for the whole community... In November 2002, the Commonwealth Government released a major report titled: “Return on Investment in Needle and Syringe Programs in Australia”. The report was done for the government by an independent group of health economists from Health Outcomes International in association with the National Centre in HIV Epidemiology and Clinical Research. The aim of the report was to show both the government and the community the economic effectiveness (or return on investment) of NSPs over the past ten years. The report indicated that the almost $150 million invested in NSPs between 1990 and 2000 has resulted in: • An estimated 25,000 cases of HIV being avoided; • An estimated 21,000 cases of hepatitis C being avoided resulting in 16,000 less chronic hep C infections and 650 fewer people living with cirrhosis; • An estimated saving of over 5,000 lives by 2010. In effect, the investment of almost $150 million had resulted in an estimated return of investment of somewhere between $2.4 and $7.7 billion. By any measure, this represented an excellent financial return on the government’s investment in NSPs. In addition to these financial benefits to the government and therefore the community, the report also showed that NSPs have had a very positive impact on both the quality and quantity of life of injecting drug users due to the deaths and diseases avoided through access to clean injecting equipment.

Constant attacks on, and closures of NSPs across the country have left many NSPs, the people who work in them and most importantly, the people who use them, feeling very vulnerable and uncertain about the future existence of these critical services. This report finally gives supporters and users of NSPs some concrete data that they can use to defend their programs and gain critical public support for their continued existence and expansion. Due to the lack of available data, this report only considers the return of investment in publicly or government funded needle & syringe programs that distribute the fits either free of charge or for a minimal cost. It did not take into account returns and benefits associated with fits sold on a commercial basis through pharmacies and vending machines. Given the large amount of equipment sold through pharmacies in particular, it is fair to suggest that the return on investment calculated in the report, is a conservative one and would be much greater if the effect of all distribution points were taken into account. This study shows that from 1991 (when NSPs were already well established in most states and territories except Tasmania) and the end of 2000; NSPs in Australia were extremely effective at preventing the transmission of HIV and hepatitis C amongst injecting drug users. After many years of struggling to retain needle & syringe programs, drug user advocates finally have the type of credible evidence that they need to support their lobbying and advocacy work in this area. The sad reality is however, that despite the effectiveness of NSPs as shown in this report, injecting drug users are still suffering unnecessarily from entirely preventable conditions and the effects of extreme marginalisation in society. If NSPs have managed to deliver such amazing results with so little political and community support, imagine what could be achieved if the whole community really worked together on improving the health of users! by AIVL Policy Team

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n this paper I will explore some of the issues that have arisen for me in my work in drug user self-organising in the Northern Territory (NT) over the period July 1995 to July 2002 .1 These issues range from anecdotal experiences that occurred during that period to personal reflection and comment on the nature of drug use and drug user self-organising in the Northern Territory, primarily focussed on my involvement with drug users in the Darwin metropolitan area  .2 I will also discuss and explore specific issues relating to research in the illicit drugs areas as well as share some insights from my involvement as a member of the Ministerial Task Force on Illicit Drugs (Task Force) .3 I’ve chosen to title this piece “It’s Different in the Territory, Mate!” as it is a phrase that I heard repeatedly whilst living in Darwin and travelling and working throughout the Territory over my time there. Being of the inquisitive mind, I always had to ask, “Different to/ from what?” Not once did I get a satisfactory answer (i.e. one that did not lead to a further question) but I certainly got many, many excuses - which I will explore later in this article.

she was collecting equipment. I met Lorraine as she was studying at the local University and needed to do a placement as part of her course. Lorraine’s approach to me was very sheepish, quiet, almost a whisper. After a few minutes, I worked out the situation and immediately said, “Yes, when can you start, what is it that you want to learn, how many hours do I get you from you each week and for how long?” The next few months during Lorraine’s placement and the time since then has not only shown the value in us educating each other, it is also shows the success in doing so: Lorraine has continued her involvement in drug user organising and is now one of the Coeditors of the recently funded drug user magazine that is being produced by the Territory Users’ Forum (TUF) .5 As many reading this paper will know, the Northern Territory is considered to be one of the most remote areas of Australia. This remoteness brings itself to the fore in many areas when working with drug users, even when discussing issues such as blood borne viruses. One of the components of being remote is isolation - isolation not only from the rest of Australia but, in particular and specifically for contract workers in remote areas, isolation from their regular drug user networks and access to appropriate injecting equipment.

I know that drug user self-organising works in the Territory in that I have helped to educate at least one person to become involved in the movement and that person has got at least one other, so the cycle continues. The specific example I use is from a person I met in my work at the needle exchange in Darwin.4 I first met Lorraine, as I will call her for the purposes of this article, many, many occasions after I first served her whilst

Once, when discussing hepatitis C (HCV) over the telephone with a worker in a remote area, we went over various areas of HCV and never touched on mode of transmission. In a follow-up conversation sometime later, he said, “I got it from a transmission, mate! You know, one of those little transfusions so many of us got before the exchanges opened.” Unfortunately, at the time of this incident I wasn’t working in, for, or with a drug user organisation so he and I had to waste a conversation when he wanted some specific information on injecting but

 1. With the exception of an eight (8) month period from February to October 2002, when I had a brief sojourn to Tasmania. 2.  For me, this includes the Palmerston and Rural areas but many Territorians would be significantly annoyed at my inclusion of Palmerston and the Rural area in the Darwin Metropolitan area. So be it.  3. The Task Force report can be found by visiting www.health.nt.gov.au and clicking through via the Illicit Drugs Task Force Report.

 4. I use the term needle exchange deliberately as 1) that was the terminology being used at the time and 2) the public relations exercise in the change over from needle exchange to NSP was a disaster in not only not educating the general public about why the change in terminology but also failed dismally to educate many drug users to the point where users collecting equipment at the NSP would ask, “So where do we get rid of our equipment now that this isn’t an exchange?” 5. www.tuf.org.au

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didn’t know how to ask, and I, not wanting to assume - didn’t! If, on the other hand, there was a funded drug user organisation in the NT he would have been able to call, not have to worry about how to break the ice and the workers could, and should - assume!

for Injectors in the Northern Territory) to offer: 1) a more positive acronym than DIVE; and 2) acknowledge that our issues were more than about injecting and included other health issues as well.

Drug user self-organising in the Territory, as there has never been a funded, peer-based drug user organisation in the NT, has an interesting past. Whilst there have always been drug users in the NT and much, much activism on the part of a few, the ability to undertake any long-term, well thought out programs over more than a few months or years has never happened. Until recently - but we’ll get to that.

At this stage, HINT was a ‘member’ of AIVL. In early 2000, I left the Territory and moved, for a brief time, to Tasmania. Shortly after this, a group of drug users in Darwin approached the AIVL Secretary insisting that the delegates to AIVL from the NT be drug users and not people working for or with us. Fortunately, this occurred and the Top End Users’ Forum (TUF) was formed and then incorporated in July 2000.

From the early seventies in the NT there have been a few attempts at drug user self-organising, initially starting with a movement around marijuana smokers and then, in the early nineties, AIVL was funded to undertake a small project across a wide area for a limited amount of time. Nevertheless, the work done during that period was remarkable. Ruth Birgin, as project officer, undertook a wide range of activities around drug user self-organising, gained much media attention to highlight the lack of services and was able to work with a range of bureaucrats to ensure that the voice of drug users was indeed heard. Unfortunately, the funding for this project ended, the momentum faded and eventually the organisation, as it stood at the time, folded. In 1995 I became involved with what was then called TUG - (Territory User’s Group) which then evolved into to DIVE (Darwin IntraVenous Education) which was a project of the NT AIDS Council. In 1997, when I was employed by the AIDS Council, I, in consultation with a range of users, changed the name of the project to HINT (Health

Since the formation of TUF, the organisation has had some remarkable achievements: • Been key participants in the Northern Territory’s “Hepatitis C, Injecting Drug Use and Needle & Syringe Program Needs Assessment”; • Successfully tendered for a “User’s Magazine” to educate injectors about hepatitis C and other issues related to injecting drug use; • Successfully lobbied to ensure that drug user representation and consultation were an integral component of the NT’s Ministerial Task Force on Illicit Drugs; • Maintained a constant media presence with regard to issues affecting the lives of drug users, particularly with regard to the lack of maintenance based pharmacotherapies and the “drug house” legislation; and; • Achieved “Level One” membership status in AIVL. As an aside to the drug user self-organising theme of this paper, and adding further confusion to the issues around the availability of maintenance-based pharmacotherapies, in November 2002 the Minister for Health, Jane Aagaard, announced the formation of a Ministerial Task Force on Illicit Drugs, which was to look at a variety of issues with regard to illicit drugs in the Northern Territory .6 Many of us saw this as a way of not dealing immediately with pharmacotherapies but we decided to participate in the process as well as to continue to call for the immediate availability of pharmacotherapies. Through much lobbying, letter writing and advocacy, I was appointed to the Task Force to represent the interests of illicit drug users .7 Initially, I found the process quite daunting: although I had sat on various bodies over the years, the importance of this one, to me, was huge and I felt as if I had more burden than I could bear, at times. Nevertheless, I went along to the first meeting of the Task Force and my fears were eased: my years of involvement with the drug 6. See footnote 2 for more information on the Task Force, its Terms of Reference and the Report. 7. How one person with a specific drug using history can represent all drug users is beyond me and it is the bones for another paper.

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user movement, as well as my personal experiences as a drug user, had equipped me with the tools I needed to actively participate in the Task Force .8 In fact, I felt, and know, that my contribution to the Task Force was greater than many other members. Much, much credit for my ability to contribute at this level must be given to the drug user movement in Australia as that is where I have gained many of my skills - thank you AIVL. As I have noted above, Labor, whilst in campaign mode, made election promises that maintenance based pharmacotherapies would be available to Territorians with opioid dependencies. As also noted above, some found the Task Force as a way of putting off the introduction of methadone and other Commonwealth approved pharmacotherapies. As a Task Force member, I was quite aware that the Terms of Reference for the Task Force around pharmacotherapies had nothing at all to do with whether or not there would be pharmacotherapies, but how they would be made available - their “practical application”. If only the various bureaucrats and Ministerial advisors were aware of the same Terms of Reference, the constant media attention on this issue would have been less and the treatments could have been made available. But no, that was not the case and Territorians with opioid dependencies could still not access maintenance based pharmacotherapies for an entire year after the new government was elected. One of the more interesting experiences that occurred during my time on the Task Force was at a cigarette break after one of the Task Force’s community consultations. During the process of the consultations the Chair introduced the members and I was of course introduced as the being from TUF as well as being an Executive Member of AIVL. This had both good and bad consequences. Good consequences, in that a range of people approached me after the various consultations to talk with me about their drug use and ways of networking with drug users outside of the major centres (Alice Springs and Darwin). Bad consequences, in that it opened up the opportunity, particularly for ex-drug users, to try to “show me the way”. One ex drug-user in particular felt he had the need to inform me that, though once an addict, he had been clean for sixteen years. I pointed out to him that I bathed daily and, sometimes during the ‘Build-up’ and the ‘Wet’, three or four times daily. End of conversation - he could go back to his cigarette and I to look for a place to self-medicate. Back to the main theme of this paper - drug user self-organising. In February of 2002, I took over as Convenor when TUF’s then Convenor decided to stand down for a variety of reasons .9 At this stage, Labor had been in Government for almost six months 8. This would, of course, have been an appropriate opportunity for a second drug user to be on the Task Force so as to gain the skills I have, fortunately, been able to acquire.

and drug users still had no access to maintenance based pharmacotherapies, despite this being not only an election promise but an issue that various politicians had discussed during the election campaign. Needless to say, we in TUF were incredibly disappointed and decided to hold a rally to bring the issue to the attention of the media, the public and, most of all, the politicians who were elected to represent us and who were not living up to their political promises. It needs to be said that whether or not TUF should’ve held a rally at all was a contentious issue. Many of us,including myself, were not comfortable in doing so but we all went with what the organisation decided and we held a rally concentrating on the issues of pharmacotherapies and drug house legislation. Whilst the rally did not get immediate change, it did manage to do two things: 1. Bring to the attention of Territorians, Australians and citizens of the world, that our elected representatives were not living up to their political promises and we still did not have maintenance based pharmacotherapies for people with dependencies, instead we had archaic drug house legislation. 2. Act as a catalyst for the formation of the Network Against Prohibition (NAP)

.10

Now that the Territory has two drug user organisations, it is vital that those organisations work out effective methods of communication and collaboration so as to ensure the continued viability and sustainability of both organisations. While one colleague has compared the relationship between drug user organisations that provide services and drug user organisations that are 9. The contribution made by Helen, also now one of TUF’s Magazine Co-editors, to drug user self-organising in the NT is phenomenal - thanks Helen! 10. www.napnt.org

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entirely in-your-face activism as being similar to the relationship between the IRA and Sinn Fein, I propose that the relationship is more like the relationship between ACT UP and AIDS Councils. ACT UP, which existed for a little over two years in Australia, had a cantankerous relationship with the various funded AIDS bodies. Ten years on, the funded AIDS organisations still exist and ACT UP, in Australia, doesn’t. There are many, many lessons to be learned from the relationship between ACT UP and other AIDS organisations in the early 1990s - to not do so could be an end to two strong, vibrant and much, much needed organisations. The next issue I would like to touch on is the issue of research with regards to illicit drugs in the NT. Given that Ministers from the previous NT Government continuously declared: “There will be methadone in the NT over our dead bodies!” It is of little surprise that there is an almost empty chasm when it comes to illicit drugs research in the Northern Territory and even less when it comes to peer-driven research. In 1997 when I began work as the HINT Coordinator, I had been in Darwin for just over eighteen months. While I knew much about the drugs used, how they were used and who was using them in my social network, I knew little at all about the drugs being used by most of the users accessing the NSP I coordinated. Given that one needs to know what is being used before one can develop resources around issues specific to those drugs, I undertook a small survey which I called a “Snapshot” .11 Over the next three years, three more snapshots were conducted, enabling me as a worker to get a better picture of what drugs are being used and how they were being used amongst clients of the NSP. This model of survey was also conducted in Alice Springs and has now been taken on by the AIDS/STD Program of the NT Department of Health & Community Services as a required product of primary NSP Outlets in the NT.

approached by a number of researchers with a whole variety of questions. The one that is most often repeated is: “Why didn’t you have an identifier where you could track people over time?” Simple answer to that one: the surveys were conceived and implemented over a four week period with the author having little real research experience. In hindsight, many, many issues regarding the Snapshots could be improved. Again, this has to be properly resourced and not just something dumped on agencies operating NSP outlets because someone in another outlet did it successfully with no extra funding. I’m now close to the end of this article and I find myself wondering: “What is that is so different about the Territory?” For me, I don’t see much. I’ve discussed a range of issues from drug user self-organising and needle exchanges, to taskforces and research and I just don’t see what the difference between my experiences in the NT and my experience in four other states and territories except for one thing... no where else in Australia have I been told: “If you keep campaigning for mobile needle exchanges you’ll ensure the whole program is closed down.” This from someone who supposedly had an understanding of and claimed to be a supporter of harm reduction! by Charles Roberts Charles Roberts has lived and worked in the Northern Territory in capacities ranging from service consumer to service provider, consultant to organiser, bureaucrat to troublemaker and - maybe, just maybe - activist. While, until recently, the Convenor of the Territory Users’ Forum and an Executive Member of AIVL, the views expressed in this article are entirely his own and do not represent the views of either TUF or AIVL.

Since those surveys were initiated, the West Australian Health Department has also taken up this model for the NSPs based in WA. While this is all well and good for the funding bodies (they can now show ‘outcomes’) it does nothing at all to address the real needs of peer-driven research nor does it acknowledge the reason why the Snapshots were initiated in the first place: a worker needed information and knew the best way to get that information was via a survey of clients of the NSP. Fortunately, I happened to have the skills to formulate surveys, design databases and analyse data, those are not normally the skills that are required attributes for people working in NSPs. If more and more funding bodies are going to require their agencies operating NSP outlets to undertake such research they will need to drastically increase their funding so as to enable said agencies to employ researchers - peer researchers! Since the initiation of the abovementioned Snapshots, I have been 11. For copies of Snapshots II, III, IV visit www.octa4.net.au/ntac/snapshot/

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ollowing the NSW Drug Summit in 1999, the NSW Health Department provided funding to Area Health Services to expand and improve the services provided to patients in public methadone programs. The Western Sydney Area Health Service established a Methadone Enhanced Health Treatment (MEHT) program from this funding source, and has provided a range of services relating to hepatitis, dental health, employment and education, and patients’ children. MEHT has also provided advice, assistance and referral in relation to other issues, including coming off methadone treatment, accommodation, financial and legal problems, and psychological and women’s health problems. The people developing the MEHT program, recognised that injecting drug users tend to under-access general health services, and they are at high-risk for blood borne viruses. Based on this, they thought that offering testing for blood borne viruses within a methadone program would provide an excellent opportunity to look at hepatitis C issues, as well as possibly preventing hepatitis B amongst this group of injecting drug users. The aim of the MEHT Hepatitis Service has been to: • check whether the methadone patients have hepatitis C or hepatitis B; • monitor their health; • help them to access treatment for hepatitis C; • prevent infection and further transmission.

Beliefs about their own hepatitis C status: • 87% believed that they currently had hepatitis C, 8% said they didn’t know, and 12% said they believed that they did not have it. • 91% said that they had previously been tested for hepatitis C. • Of those who had ever been tested, 85% said that they had tested positive for hepatitis C, 13% said that the test result was negative and 2% didn’t know. Knowledge about hepatitis C: • When asked “Do any of your friends have hep C?”, 8% said “don’t know”, and 5% said “no”. • When asked if hep C can be transferred to someone else by sneezing, 10% said “don’t know” and 3% said “yes”. • When asked whether hep C can be transferred by needle-sharing, 99% said “yes”. Results from testing: • 93% were hepatitis C positive (90% of males and 100% of females). • 85% of the youngest age group were hepatitis C positive. • 48% did not show evidence of past exposure to hepatitis B. • 50% showed elevated liver function tests (LFTs). • 5% were infected with both hepatitis B and hepatitis C. Figure 1: Prevalence of Hepatitis C

Because taking blood from methadone patients can be difficult due to problems with vein condition, the program had a nurse on-site who was skilled in taking blood under such circumstances, as well as being experienced in pre-test and post-test counselling, interpretation of blood test results and drug and alcohol issues. When the blood test results were ready the patient was given: • an interpretation of the results; • information about prognosis if the person was hepatitis C or hepatitis B positive; • referral and follow-up was arranged as appropriate; • information about transmission and prevention of hepatitis including information and implications for their existing partners, friends, contacts; • a letter informing their methadone prescriber of the test results. People who participated in the service were asked to answer a brief questionnaire before blood was collected for testing. The information below provides a snapshot of questionnaire results from 97 patients who accessed the MEHT Hepatitis Service:

Percentage Positive

100%

97%

95% 90% 85%

100%

90% 85%

80% 75%

19-26yrs

27-34yrs

35-40yrs

41-53yrs

Age Group A comparison between patients’ beliefs about their hepatitis C status and their actual test results was also interesting. All of the patients who had said that they had hepatitis C were correct, 95% of those who said “don’t know” were, in fact, positive, and 50% of those who said that they “did not have hepatitis C” were positive. Patients showed a high level of interest in undertaking treatment for hepatitis C if infected - 82% of patients had said on their questionnaire that they were “probably interested” or “definately interested”. by Erol Digiusto, Lenore Riveros, Frances Tenison 1. Drug and Alcohol Service, Western Sydney Area Health Service 2. Hepatitis C Clinical Co-ordinator, Western Sydney Area Health Service

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nd so it was, feeling stimulated I attended the Intergovernmental Committee on Drugs/National Drug and Alcohol Research Centre’s invitation only, “Psychostimulants Forum” and what a whiz of a day I had! On entering the Sydney Masonic Centre it became clear that there was quite a significant amount of law enforcement present (over a third to be exact), some researchers, a couple of national organisations for example the Australian National Council on Drugs (the secretariat for the Prime Minister’s Advisory Committee on alcohol and other drug issues), service providers, bureaucrats and us, well me, there were no other consumers there. I have to also thank the organisers of the day who gave me a lovely badge to wear with my name on it and in big letters, “DRUG USERS LEAGUE”. Stick out like a sore thumb? Maintain some anonymity? I think not. Still at least it wasn’t a flashing neon light... “look everyone, here is the lonesome official consumer representative, haven’t we done

well?”. I say ‘official’ because there were a few covert consumers present. You know, talk about it in the breaks... “oh sweetie fabulous pills at the weekend washed down with a bucket of ice”... but never admit anything in public types! An apology for the sarcasm but, this kind of thing just has to stop. We cannot be expected to talk about the issues that effect user’s lives in such oppressive environments and for this to be seen as appropriate consultation. Nobody else has to indicate that they possibly break the law and neither should we in such an exposed manner. Anyway enough of that, let’s get down to what the day achieved. Sadly, there were no real aims and objectives for the day. This seemed a bit strange to a few of us still ,nevertheless, there was a plan with the day being split into two sections: 1. The Treatment Research Context 2. Frontline/Emergency Context I decided to join the Frontline/Emergency Context session. The reason for

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this, is due to the feedback I get from individuals about how they are treated by frontline workers and also, because frontline workers seem to be ‘up in arms’ about working with psychostimulant users. When I worked in the drug and alcohol sector in the UK between 1995-2000, I worked with heaps of crack users. Now, true enough, some of them were barking mad, but it did not stop them accessing HOT (the service I used to manage)or any of HOT’s peer and nonpeer workers. We all worked together. So, this whole uproar from so called services does not sit too well with me really - I just think drug workers and others involved in ‘treatment’ are too used to relatively quiet opiate users and yacking manic psychostimulant users are quite frankly, making them work...) The day was opened by Ms. Sue Kerr from the Commonwealth Department of Health & Ageing and the InterGovernmental Committee on Drugs (IGCD). She spoke of, amongst other issues, the need for there to be clear guidelines for working with psychostimulant users and to enhance the capabilities of front line workers. Libby Topp from the National Drug and Alcohol Research Centre (NDARC) gave an overview of relevant research being undertaken on psychostimulants within Australia and then, there was a presentation by Detective Inspector Paul Willingham of the NSW Police on supply reduction strategies in relation to psychostimulants. He reported that ‘drug hauls’ had increased over the years; two thirds of Australia’s amphetamine labs are in Queensland and that in NSW, WA, VIC and SA they are finding about one amphetamine lab per fortnight. He also mentioned that it appears that PCP is making a come back in NSW. Let angels dust their wings and fly! Letters to JUNKMAIL verifying this would be most welcome! We then broke into our groups and it sadly went down hill from there. We were told about guidelines for interacting with psychostimulant users that are being updated. AIVL is hoping to have input into this however, it is very difficult for us with such limited resources to make sure we get our voice heard in every initiative. AIVL receives funding to undertake educational activities

and policy work in respect of blood borne viruses and injecting drug use but has not yet received funding to undertake work to address the broader range of issues in relation to illicit drug use. This makes it extremely difficult for us to meet all of the demands on us in relation to representing lllicit drug users at the national level. Still, we will try as ever! Ron Henderson from the Queensland Ambulance Service then took the stage and reported that there are now: • more violent and aggressive emergency attendances; • to get people to hospital more police are having to be involved; • there is more reliance on sedating users and using physical restraints; • paramedics are being called to watch-houses more frequently; • in NSW there is an increase in users not managing the effects of MDMA (ecstasy); • treatment agencies are calling ambulances more often. During this session language such as “difficult group to manage” and “how do we best manage these people” was used frequently. Next up, Annie Malcolm from Kirketon Road Centre gave a presentation on the flow chart that they have developed for working with psychostimulant users. This presentation also included references about psychostimulant users being “totally irrational”. Now as you can imagine, from AIVL’s perspective this was all a bit worrying. If anybody or anything was ‘irrational’ it was how this forum was turning out. You see, from my perspective the whole psychostimulant debate is itself becoming out of control. It is common knowledge that alcohol is still the worse denominator for violent behaviour, but where is the hysteria about that? Examples were being presented of people in ‘methamphetamine frenzies’ doing things such as walking in the traffic over Sydney Harbour Bridge and getting run over; gouging their eyes out; and one person cutting off his fingers and his penis. While I am not challenging whether these scenarios actually happened, or that they are really unfortunate events, the fact is that THEY ARE NOT THE NORM. It is simply unacceptable to be presenting such extreme examples when trying to achieve rational and meaningful discussion in relation to methamphetamine use and improving drug users lives. I was sitting next to representatives of the

37


Sydney Ambulance Centre and I challenged them every time some bizarre evidence was presented. They cover an area of Sydney with high psychostimulant use and stated that they rarely came across the ‘nightmare’, violent people that were being described. Barry McMahon, again of NSW Police, it has to be said was OK. He spoke on the subject of safe custody issues. This is a really important issue and on the whole, he treated the subject well. In police custody there is a average of seventy-two people testing positive to amphetamines. In Paramatta twenty percent of people coming into custody are testing positive for amphetamines. Lots of people and guess what - NO SELF HARM. This presentation however, then also got a bit scary with discussions as to which police stations in Australia have padded cells, which restraints are best to use on psychostimulant users and that in future, case management sessions for those in treatment to include police and paramedics! Well, at this point it all became too much for this Welsh girl so I told my heart palpitations to get lost and took a deep breath and asked: “Police activities such as clubs being raided, the use of sniffer dogs on the streets, drug house legislation and self administration laws create harm. What are you going to do about that? What is the role of harm reduction, community development, and peer education and where is the realistic drug information? What are ‘services’ doing about educating users so they can manage anxiety, heart palpitations and feelings of paranoia? Why is there such an investment in blatant stereotyping? Where are user’s rights in these debates?” I had a fantastic response to my points and questions... SILENCE. You could have heard a pin drop. One police officer then questioned my questioning of law enforcement and I had to tell him that people are using more drugs in one go due to fear of law enforcement, that people’s injecting standards are being compromised for fear of being caught and that this places people at higher risk of blood borne viruses. Sue Kerr then added that these issues had indeed been overlooked and needed addressing however, there was no further conversation on the matter for the duration of the day. The ‘icing on the cake’ though was all the people, as we broke up for afternoon tea, who came up to me saying how brave I was to raise such issues, that they agreed and comments such as “it is great to have user reps at these events because, I can protect myself as a user by not having to raise them... you know, my job and everything”. Well, to all you hypocrites - no, I do not understand. As psychostimulant users you have the responsibility to make sure that you do speak out. The more that this is the case, the less able nonusers are to present psychostimulant users as ‘mad head-cases’. It is not acceptable at all. One of my thoughts is that the main reason that ‘professionals’ in the field have such an investment in

making sure that psychostimulant users are mad is because, some of them are psychostimulant users themselves and having ‘mad ones’ allows for differentiation... “no, I am not one of them. I toot mine sweetie up the nostrils, or I swallow mine from my favourite shot glass or I simply pop and swallow.” No, I am not the injector, or the user with obvious mental health problems who needs support, not judgement. So in summary, from AIVL’s perspective the forum is and was a great source for concern. Psychostimulants have always been around, particularly here in Australia. We need to stop the hysteria and we need to do it now. Psychostimulants are the new evil. Join in now on the crusade to stop this from becoming even uglier. If you are a user, talk to your local drug user organisation about how you and your peers can better self manage your use, learn how to manage things like heart palpitations, feelings of anxiety and how to become aware of feelings of paranoia. Many of you may laugh at such strategies and I know that there are some users out there who, with the added factor of mental health problems, can just flip out. But it is like this. Unless you start to take control, others will take control of you. We owe it to each other to do what we can for ourselves and each other. Stand up for you rights. Stand up for your health and last, but by no means least, stand up for the truth! by Nicky Bath AIVL Policy Officer

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AIVL resouces are available free of charge to drug users through AIVL member organisations (see the AIVL directory on the facing page for details). Other services and organisations wishing to obtain bulk copies of AIVL resources should contact the AIVL national office for an order form and to arrange payment and delivery.

“POSITIONAL”

• See directory on the facing page for national office details •


NAME ADDRESS POSTAL PHONE PHONE FAX E-MAIL WEBSITE NAME ADDRESS POSTAL PHONE FAX E-MAIL

NAME ADDRESS POSTAL PHONE FAX E-MAIL

NAME ADDRESS POSTAL PHONE FAX

NAME ADDRESS POSTAL PHONE FAX E-MAIL

AIVL

NUAA

Level 2, 112-116 Alinga Street Canberra, ACT 2600 GPO Box 1552 Canberra ACT 2601 (02) 6279 1600 (Head Office) (02) 9360 5065 (Sydney Office) (02) 6279 1610 info@aivl.org.au www.aivl.org.au

345 Crown Street Surry Hills, NSW 2010 PO Box 278 Darlinghurst NSW 1300 (02) 8354 7300 1800 644 413 (toll free) (02) 8354 7350 admin@nuaa.org.au

DUNES

TUF

2019 Goldcoast Highway Miami, QLD 4220 PO Box 224 Miami Qld 4220 (07) 5520 7900 (07) 5520 7344 info@dunes.org.au

2 Stretton Street Parap, NT 0820 PO Box 835 Parap, NT 0804 (08) 8941 2308 No fax contact darwin@tuf.org.au

SAVIVE

USERS Assoc. SA

64 Fullarton Road Norwood, SA 5067 PO Box 907 Kent Town SA 5071 (08) 8334 1699 (08) 8363 1046 manager@savive.org

No premises C/- Michael McGregor PO Box 167 Kent Town BC SA 5071 C/- (08) 8334 1699 C/- (08) 8363 1046 No email contact

NAP

VIVAIDS

2 Stretton Street Parap, NT 0820 PO Box 701 Parap NT 0804 (08) 8942 0570 • 0415 162 525 No fax contact naphq@bigpond.net.au

275b Smith St reet Collingwood, VIC 3066 PO Box 2435 Fitzroy Vic 3065 (03) 9419 3633 (03) 9415 7055 drugsafe@vicnet.net.au

WASUA

CAHMA

440-444 William Street Northbridge, WA 6003 PO Box 290 Maylands WA 6931 (08) 9227 7866 (08) 9227 7855 info@wasua.com.au

G33, Griffin Centre 19 Bunda Street Canberra, ACT 2600 PO Box 78 Braddon ACT 2612 (02) 6262 5299 (02) 6262 8381 nicole@cahma.org.au


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